generate qr code excel B Laboratory Testing and Imaging in Objective-C

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B Laboratory Testing and Imaging
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Serum androgen testing is mainly useful to screen for rare occult adrenal or ovarian neoplasms Some general guidelines are presented here, though exceptions are common Serum is assayed for total testosterone and free testosterone A serum testosterone level > 200 ng/dL or free testosterone > 40 ng/dL indicates the need for pelvic examination and ultrasound If that is negative, an adrenal CT scan is performed A serum androstenedione level > 1000 ng/dL also implicates an ovarian or adrenal neoplasm Patients with milder elevations of serum testosterone or androstenedione usually are treated with an oral contraceptive Patients with very elevated serum DHEAS (> 700 mcg/dL) have an adrenal source of androgen This usually is due to adrenal hyperplasia and rarely to adrenal carcinoma An adrenal CT scan is performed No firm guidelines exist as to which patients (if any) with hyperandrogenism should be screened for late-onset 21hydroxylase deficiency The evaluation requires levels of serum 17-hydroxyprogesterone to be drawn at baseline and at 30 60 minutes after the intramuscular injection of 025 mg of cosyntropin (ACTH1 24) This test should ideally be done during the follicular phase of a woman s menstrual cycle Patients with congenital adrenal hyperplasia will usually have a baseline 17-hydroxyprogesterone level over 300 ng/dL or a stimulated level over 1000 ng/dL The diagnosis, once made, is interesting academically but not helpful to the patient since corticosteroid treatment is not particularly more effective in this condition than are other treatment modalities (see below) Patients with any clinical signs of Cushing s syndrome should receive a screening test (See Cushing s Syndrome) Serum levels of FSH and LH are elevated if amenorrhea is due to ovarian failure An LH:FSH ratio greater than 20 is common in patients with PCOS On abdominal ultrasound, about 25 30% of normal young women have polycystic ovaries, so the appearance of ovarian cysts on ultrasound is not helpful So, the polycystic ovary syndrome is actually a misnomer and the diagnosic criteria for PCOS does not include imaging evidence of polycystic ovaries
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Elevated plasma and urine aldosterone levels and low plasma renin level
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Metformin can be taken by nondiabetics without causing hypoglycemia Clomiphene is the treatment of choice for women with PCOS and infertility Over 6 months, clomiphene therapy resulted in a 225% rate of conception with live births The rate of pregnancy with multiple fetuses is 6% Local treatment by shaving or depilatories, waxing, electrolysis, or bleaching should be encouraged Eflornithine (Vaniqua 139%) topical cream retards hair growth when applied twice daily to unwanted facial hair; improvement is noted within 4 8 weeks However, local skin irritation may occur Hirsutism returns with discontinuation Laser therapy is an effective treatment for facial hirsutism, particularly for women with dark hair and light skin; complications include skin hypopigmentation (rare) and hyperpigmentation, which occurs in 20% but usually resolves Women with androgenic alopecia may be effectively treated with topical minoxidil 2% solution applied twice daily to a dry scalp Hypertrichosis is an unwanted side effect of topical minoxidil, occurring in 3 5% of treated women; it may affect the forehead, cheeks, upper lip, or chin Hypertrichosis resolves within 1 6 months after the drug is stopped Note: Antiandrogen treatments must be given only to nonpregnant women Women must be counseled to take oral contraceptives, when indicated, and avoid pregnancy, since use during pregnancy causes malformations and pseudohermaphroditism in male infants
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Azziz R et al Androgen excess in women: experience with over 1000 consecutive patients J Clin Endocrinol Metab 2004 Feb;89(2):453 62 [PMID: 14764747] Ganie MA et al Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-label study J Clin Endocrinol Metab 2004 Jun;89 (6):2756 62 [PMID: 15181054] Murphy MK et al Polycystic ovarian morphology in normal women does not predict the development of polycystic ovary syndrome J Clin Endocrinol Metab 2006 Oct;91(10):3878 84 [PMID: 16882750] Ortega-Gonzalez C et al Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome J Clin Endocrinol Metab 2005 Mar;90(3):1360 5 [PMID: 15598674] Palomba S et al Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome J Clin Endocrinol Metab 2005 Jul;90(7):4068 74 [PMID: 15840746] Rosenfield RL Clinical practice Hirsutism N Engl J Med 2005 Dec 15;353(24):2578 88 [PMID: 16354894]
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