Questions & Answers https://emedicine.medscape.

com/article/273153-questions-and-answers

Updated: Apr 07, 2020

Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG
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QUESTIONS & ANSWERS

Overview

What is androgen excess?

What are sources and types of androgens in women?

What are ovarian androgens?

What are adrenal androgens?

What are the peripheral sites of androgen production?

Which androgens activate androgen receptors?

Which factors increase or decrease sex hormone binding globulin (SHBG) levels?

Which androgens are bound to albumin?

What is the role of adrenal androgens in androgen metabolism?

What are effects of androgens?

How do androgens affect various tissues and systems?

How do androgens affect the brain?

How do androgens affect bone?

How do androgens affect the breast?

How do androgens affect the endometrium?

How do androgens affect the cardiovascular system?

What is the mechanism of androgen action?

How does androgen excess affect hair growth?

What is the role of androgen excess in the pathogenesis of acne vulgaris?

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What is the role of androgen excess in the etiology of anovulatory infertility?

What is the role of androgen excess in the etiology of hyperinsulinemia?

How is the pattern of androgen excess affected by etiology?

What is the prevalence of androgen excess in the US?

What is the global prevalence of androgen excess?

What is the mortality and morbidity of androgen excess?

What are the racial predilections of androgen excess?

How does the prevalence of androgen excess vary by sex?

What age groups are at highest risk for androgen excess?

Presentation

Which history findings are characteristic of hirsutism?

What should be the focus of history of women with hirsutism?

What are the signs and symptoms of polycystic ovary syndrome (PCOS)?

What does a finding of virilization suggest in the evaluation of androgen excess?

Which physical findings are characteristic of hirsutism?

What is the Ferriman-Gallwey Scoring System and how is it used in the evaluation of androgen
excess?

Other than hirsutism, what are signs of androgen excess?

What is the role of polycystic ovary syndrome (PCOS) in the etiology of androgen excess?

What is the role of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN)
syndrome in the etiology of androgen excess?

What is the role of ovarian hyperthecosis in the etiology of androgen excess?

What is the role of congenital adrenal hyperplasia in the etiology of androgen excess?

What is the role of Cushing syndrome in the etiology of androgen excess?

What are androgen secreting tumors and how do they cause androgen excess?

How does hyperprolactinemia cause androgen excess?

How does pregnancy cause androgen excess?

What is the role of exogenous androgens in the etiology of androgen excess?

DDX

What are the differential diagnoses for Androgen Excess?

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Workup

What is the role of lab studies in the evaluation of androgen excess?

What is the role of testosterone measurement in the evaluation of androgen excess?

What is the role of dehydroepiandrosterone sulphate (DHEAS) measurement in the evaluation of

androgen excess?

What is the role of 17-hydroxyprogesterone measurement in the evaluation of androgen excess?

What is the role of thyroid-stimulating hormone measurement in the evaluation of androgen excess?

What is the role of prolactin measurement in the evaluation of androgen excess?

When is extensive testing indicated in the evaluation of androgen excess?

What is the role of ultrasonography in the evaluation of androgen excess?

What is the role of computerized tomography (CT) scan and MRI in the evaluation of androgen
excess?

When is an oral glucose tolerance test (OGTT) indicated in the evaluation of androgen excess?

When is 24-hour urine free cortisol measurement indicated in the evaluation of androgen excess?

When is a synthetic ACTH (corticotropin) stimulation test indicated in the evaluation of androgen
excess?

When is a dexamethasone suppression, 2-day test indicated in the evaluation of androgen excess?

When is GnRH analog suppression testing indicated in the evaluation of androgen excess?

What is the role of ovarian and adrenal vein sampling in the evaluation of androgen excess?

Treatment

What are the treatment options for androgen excess?

How is androgen excess managed in women with polycystic ovary syndrome (PCOS)?

What is the role of surgery in the treatment of androgen excess?

Which specialist consultations are needed for the management of androgen excess?

Which dietary modifications are used in the treatment of women with androgen excess?

Which activity modifications are used in the treatment of women with androgen excess?

Medications

What is the role of drug treatment for androgen excess?

Which medications in the drug class Antiparkinson Agents, Dopamine agonists are used in the
treatment of Androgen Excess?

Which medications in the drug class Topical skin products are used in the treatment of Androgen

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Excess?

Which medications in the drug class Insulin-sensitizing drugs are used in the treatment of Androgen
Excess?

Which medications in the drug class Corticosteroids are used in the treatment of Androgen Excess?

Which medications in the drug class Gonadotropin Releasing Hormone Antagonists are used in the
treatment of Androgen Excess?

Which medications in the drug class 5-Alpha-Reductase Inhibitors are used in the treatment of
Androgen Excess?

Which medications in the drug class Aldosterone Antagonists, Selective are used in the treatment of
Androgen Excess?

Which medications in the drug class Antiandrogens are used in the treatment of Androgen Excess?

Which medications in the drug class Oral contraceptives are used in the treatment of Androgen
Excess?

Follow-up

What long-term monitoring is needed for women with androgen excess?

What is the prognosis of androgen excess?

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