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Hirsutism, acne, alopecia, menstrual dysfunction, oligomenorrhea, or polycystic ovaries?

EVALUATION OF PATIENTS WITH POTENTIAL HYPERANDROGENISM. Hirsutism, acne, alopecia, menstrual dysfunction, oligomenorrhea, or polycystic ovaries?. Yes. No. ‘Regular’ periods?. Clinical signs of virilization?. Clinical signs of Cushing’s Sx?. Clinical signs of Acanthosis Nigricans?. Yes. No.

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Hirsutism, acne, alopecia, menstrual dysfunction, oligomenorrhea, or polycystic ovaries?

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  1. EVALUATION OF PATIENTS WITH POTENTIAL HYPERANDROGENISM Hirsutism, acne, alopecia, menstrual dysfunction, oligomenorrhea, or polycystic ovaries? Yes No ‘Regular’ periods? Clinical signs of virilization? Clinical signs of Cushing’s Sx? Clinical signs of Acanthosis Nigricans? Yes No  P4 level day 22-24 Yes Yes Yes  Total & free T, DHEAS, TSH, Prl, 17-HP ≥4 ng/mL <4 ng/mL No No No  Total & free T, DHEAS, 17-HP  Total & free T, DHEAS; TV-US of ovaries & CT/MRI of adrenals  24-hr urine free F, or am F after 1 mg DEX h.s.  oGTT for INS & GLU Repeated TSH or Prl elevated  Total, free T, or DHEAS, or hirsutism; normal TSH & Prl 17-HP >200 ng/dL  Total, free T, or DHEAS, and hirsutism or polycystic ovaries; Nl 17-HP Nl  ACTH test Hirsute?  24-hr free F, or am F Nl Peak INS >300 IU/mL, and normal GLU Peak INS <300 IU/mL Mass detected, or repeated total T >200 ng/dL or DHEAS >6000 ng/mL No mass 17-HP <1000 ng/dL 17-HP >1000 ng/dL Yes No Evaluate for thyroid or pituitary disorder Atypical or ovulatory PCOS Evaluate for an ASN Evaluate for Cushing’s Sx Evaluate for HAIRAN Sx No hyper-androgenism PCOS IH NCAH Abbreviations: ACTH, adrenocorticotropic hormone; ASN, androgen secreting neoplasm; DEX, dexamethasone; DHEAS, dehydroepiandrosterone sulfate; F, cortisol; GLU, glucose; HAIRAN, hyperandrogenism insulin resistance acanthosis nigricans; 17-HP, 17-hydroxyprogesterone; IH, idiopathic hirsutism; INS, insulin; NCAH, non-classic adrenal hyperplasia; Nl, normal; oGTT, oral glucose tolerance test; P4, progesterone; PCOS, polycystic ovary syndrome; Prl, prolactin; Sx, syndrome; T, testosterone; TSH, thyroid stimulating hormone; TV-US, transvaginal ultrasound. Conversion factors: To convert DHEAS from ng/mL to mol/L, multiply by 0.002714; to convert INS from IU/mL to pmol/L, multiply by 6; to convert 17-HP from ng/dL to nmol/L, multiply by 0.03; to convert P4 from ng/mL to nmol/L, multiply by 3.18;to convert total T from ng/dL to nmol/L, multiply by 0.03467.

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