586 Obstetrics and Gynecology Board Review •••
❍ What are the possible treatments of hirsutism?
Hair removal and weight loss.
Vaniqa (eflornithine hydrochloride cream 13.9%).
OCP.
Spironolactone.
Flutamide.
Finasteride.
Cyproterone acetate.
Gonadotropin-releasing hormone agonist.
Glucocorticoid therapy.
Combined therapy with an estrogen-progestin contraceptive, metformin plus flutamide.
❍ What complementary/alternative therapy has been shown in randomized controlled trials to decrease
androgen levels?
Acupuncture.
❍ What is the mechanism of action of spironolactone?
It blocks the effects of androgens in the periphery at the receptor (by competing with DHT for binding to the
receptor) and has a suppressive effect on enzymes important in the biosynthesis of androgens.
❍ What is the recommended dose of spironolactone for the treatment of hirsutism?
50 to 100 mg bid.
❍ What is the difference between finasteride and dutasteride?
Dutasteride (Avodart) inhibits both isoforms of 5a-reductase, type I and type II, whereas finasteride (Propecia or
Proscar) inhibits only type II.
❍ What is the minimum period of treatment necessary to see a clinical improvement in hirsutism?
3 to 6 months.
❍ What is leptin?
A protein hormone produced by adipocytes that increases general metabolism. Abnormalities may contribute to
the metabolic disturbances in patients with PCOS.
❍ What percentage of women with PCOS meet the criteria for type II diabetes and for impaired glucose
tolerance?
7% to 10% and 35%.
❍ Define android obesity.
A waist:hip ratio >0.85. Visceral fat is more metabolically active than subcutaneous fat and results in higher free
fatty acid concentrations leading to hyperglycemia.