Hirsutism

Question 1

Describe the Ferriman-Gallwey Scoring

Answer 1

• Assesses terminal hair growth in specific androgen-sensitive body areas (classically 9 areas: upper lip, chin, chest, upper and lower back, upper and lower abdo, upper arm, thigh)
• Each area scored 0-4 based on hair density/length
• Scores are summed, giving total score (e.g. >/= 8 in Caucasian women usually defines hirsuitism, but cut offs vary by ethnicity)

Question 2

Two problems w clinical utility of Ferrimen-Gallwey score?

Answer 2

• Ethnic variation in baseline hair growth = different cut-offs
• Cosmetic hair removal -> underestimation and reliance on clinical history

Other:
- Interobserver variability

Question 3

Possible conditions causing hirsutism

Answer 3

• Late-onset CAH
• Androgen-secreting tumour (adrenal or ovarian)
• PCOS
• Cushings

Question 4

4 tests to distinguish causes of hirsutism?

Answer 4

• Testosterone, free testosterone, DHEAS, androstenedione
• 17-hydroxyprogesterone
• 24h urinary cortisol or dexamethasone suppression test or midnight salivary cortisol
• FSH, LH

Question 5

Late-onset CAH - expected lab results:

Answer 5

• High 17-OHP
• High testosterone, DHEAS & androstenedione
• Normal morning cortisol (can be low-normal or normal)
• LH, FSH - could be low/normal

Question 6

Androgen-secreting tumour - expected lab results:

Answer 6

• High DHEAS = typical (ovarian tumour = more testosterone heavy)
• Normal 17-OHP
• Normal morning cortisol (unless cortisol-secreting tumour)
• Suppressed LH, FSH

Question 7

PCOS hormonal pattern (androgens, LH:FSH, 17-OHP, cortisol)

Answer 7

• Testosterone +/- androstenedione mildly increased
• LH:FSH >2
• Normal 17-OHP and cortisol

Question 8

Cushing’s

Answer 8

• High morning cortisol
• High adrenal androgens
• Normal 17-OHP
• Suppressed LH, FSH