Hyperprolactinemia

• 17-hydroxyprogesterone
• Exaggerated Androstenedione, DHEA, and 17-hydroxyprogesterone in response to ACTH

• Low testosterone levels

• No symptoms in infancy and male

• Virilization in females

• DOC
• 11-Deoxy-Cortisol

Decreased:

• Cortisol
• Corticosterone
• Aldosterone

• Low testosterone levels

• Hypertension and hypokalemia
• Virilization

• DHEA
• 17-hydroxypregnenolone
• Pregnenolone

Decreased:

• Cortisol
• Aldosterone

• Low testosterone levels

• Salt-wasting adrenal crisis in infancy

• Mild virilization of genetically female infants
• Undervirilization of genetically male infants, making it the only form of CAH which can cause ambiguous genitalia in both genetic sexes.

• High DHEAS and androstenedione levels

• Low testosterone levels

• Polycystic ovaries in sonography
• Obesity
• PCOS is the most common cause of hirsutism in women
• No evidence another diagnosis

• Variable levels depends on tumor type

• Low testosterone level

• Older age
• Rapidly progressive symptoms

• Variable levels depends on tumor type

• Testosterone is high

• Older age
• Rapidly progressive symptoms

• Increase cortisol & metabolites
• Variable other steroids

• Variable mineralocorticoid excess

• Cushingoid appearance

• Normal levels of most of steroids

• Increased prolactin

• Infertility, galactorrhea

• Pregnancy always should be excluded in a patient with a history of amenorrhea

• Features include amenorrhea or oligomenorrhea, abnormal uterine bleeding, nausea/vomiting, cravings, weight gain (although not in the early stages and not if vomiting), polyuria, abdominal cramps and constipation, fatigue, dizziness/lightheadedness, and increased pigmentation (moles, nipples)

• Uterine enlargement is detectable on abdominal examination at approximately 14 weeks of gestation

• Ectopic pregnancy may cause oligomenorrhea, amenorrhea, or abnormal uterine bleeding with abdominal pain and sometimes subtle or absent physical symptoms and signs of pregnancy

• Diagnosis of exclusion
• Seen in athletes, people on crash diets, patients with significant systemic illness, and those experiencing undue stress or anxiety
• Predisposing features are as follows weight loss, particularly if features of anorexia nervosa are present or the BMI is <19 kg/m2
• Recent administration of depot medroxyprogesterone, which may suppress ovarian activity for 6 months to a year
• Use of dopamine agonists (eg, antidepressants) and major tranquilizers
• Hyperthyroidism
• In patients with weight loss related to anorexia nervosa, fine hair growth (lanugo) may occur all over the body, but it differs from hirsutism in its fineness and wide distribution

• Causes include reproductive system abnormalities, chromosomal abnormalities, or delayed puberty
• If secondary sexual characteristics are present, an anatomic abnormality (eg, imperforate hymen, which is rare) should be considered
• If secondary sexual characteristics are absent, a chromosomal abnormality (eg, Turner syndrome ) or delayed puberty should be considered

• Cushing syndrome is due to excessive glucocorticoid secretion from the adrenal glands, either primarily or secondary to stimulation from pituitary or ectopic hormones; can also be caused by exogenous steroid use

• Features include hypertension, weight gain (central distribution), acne, and abdominal striae Patients have low plasma sodium levels and elevated plasma cortisol levels on dexamethasone suppression testing

• Mild hyperprolactinemia may occur as part of PCOS-related hormonal dysfunction

• Other causes include stress, lactation, and use of dopamine antagonists
• A prolactinoma of the pituitary gland is an uncommon cause and should be suspected if prolactin levels are very high (>200 ng/mL)
• Physical examination findings are usually normal
• As in patients with PCOS, hyperprolactinemia may be associated with mild galactorrhea and oligomenorrhea or amenorrhea; however, galactorrhea also can occur with nipple stimulation and/or stress when prolactin levels are within normal ranges
• A large prolactinoma may cause headaches and visual field disturbance due to pressure on the optic chiasm, classically a gradually increasing bi-temporal hemianopsia

• Benign ovarian tumors and ovarian cancer are rare causes of excessive androgen secretion; adrenocortical tumors also can increase the production of sex hormones
• Abdominal swelling or mass, abdominal pain due to fluid leakage or torsion, dyspareunia, abdominal ascites, and features of metastatic disease may be present
• Features of androgenization include hirsutism, weight gain, oligomenorrhea or amenorrhea, acne, clitoral hypertrophy, deepening of the voice, and high serum androgen (eg, testosterone, other androgens) levels
• In patients with an androgen-secreting tumor, serum testosterone is not suppressed by dexamethasone

• Congenital adrenal hyperplasia is a rare genetic condition resulting from 21-hydroxylase deficiency
• The late-onset form presents at or around menarche Patients have features of androgenization and subfertility
• Affects approximately 1% of hirsute patients More common in Ashkenazi Jews (19%), inhabitants of the former Yugoslavia (12%), and Italians (6%)
• Associated with high levels of 17-hydroxyprogesterone
• A short adrenocorticotropic hormone stimulation test with measurement of serum17-hydroxyprogesterone confirms the diagnosis Assays of a variety of androgenic hormones help define other rare adrenal enzyme deficiencies, which present similarly to 21-hydroxylase deficiency

• Anabolic steroids are synthetic hormones that imitate the actions of testosterone by increasing muscle bulk and strength
• Should be considered if the patient is a serious sportswoman or bodybuilder
• Features include virilization (including acne and hirsutism), often increased muscle bulk in male pattern, oligomenorrhea or amenorrhea, clitoromegaly, gastritis, hepatic enlargement, alopecia, and aggression
• Altered liver function test results are seen

• Hirsutism is excessive facial and body hair, usually coarse and in a male pattern of distribution
• Approximately 10% of women report unwanted facial hair
• There is often a family history and typically some Mediterranean or Middle Eastern ancestry
• May also result from use of certain medications, both androgens, and others including danazol, glucocorticoids, cyclosporine, and phenytoin
• Menstrual history is normal
• When the cause is genetic, the excessive hair, especially on the face (upper lip), is present throughout adulthood, and there is no virilization
• When secondary to medications, the excessive hair is of new onset, and other features of virilization, such as acne and deepened voice, may be present