Hirsuitism

Question 1: In the process of evaluation of a patient with hirsuitism, which statment is false:
1-Total testesterone is less than 150 ng/dl in most patients with PCO
2-LH:FSH ratio is more than 3 is diagostic in patients with PCO.
3- Adrenal CT or MRI is indicated to role out adrenal androgen-secreting tumor if serum DHEA-s is > 700 mcg/dL .
4- A transvaginal ultrasound if serum total testesterone is > 150 ng/dL, and DHA is not significantly elevated.
5- Labroscopy is indicated if testesterone level is > 200 ng/dL with negative imaging of ovaries and adrenals to look for a small ovarian tumor (likely a hilus-cell tumor) that is too small to be detected by ultrasonography.

The right answer is 2, LH:FSH ratio used to one of the criteria to diagnose PCO however due to the pulsatility of LH as well findings of same ratio in some normal women the test is not helpful.

Most patients with PCO have mildly elevated or even normal testosterone level high level of 150 or more suggests ovarian or adrenal tumors. An elevated DHEA-s will suggest to adrenal tumor while a normal a DHEA will suggest ovarian tumor in this condition.

Question -2 In treatment of women with hirsuitism which is the wrong answer:
1-BCP is added if cosmetic measures and direct hair removal methods are commonly ineffective alone.
2-BCP may take more than 6 months to show effect in hirsuitism.
3- Anti-androgens typically spironolactone is added if BCP is not effective.
4- Avandia is effective in treating hirsuitism due to PCO.
5- Metformin have been shown to be effective in hirsuitism due to PCO.
6- Vaniqa cream for short course of 6 months will cure hirsuitism.
7- Flutamide to be avoided for hepatotoxicity.

The right answer is 6. BCP (Birth Control Pills) is the drug of choice if cosmetic measures are not effective alone. If it fails anti-androgens is added on or if used alone patient has to be in highly effective way of contraception since have effect on sex organs of male fetus. Typically spironolactone is used, flutamide has high risk of hepatoxicity. Cyproterone and finasteride are two other antiadnrogens. Though avandia (rosiglitzone) is effective in decreasing hirsuitism it cause weight gain and has a cardiovascular risk. Metformin in metanalysis of 8 studies found to be ineffective in diminishing hirsuitsim. Vaniqa cream will suppress hair growth temporarily and recurrence is common unless it is continued or BCP and anti-androgens are used as well.