Question

QUESTION 1 A 43 yr old female presents with increased weight gain of 35lbs over 2 month period specifically in her central body area, increased hair growth, acne and menstrual irregularity. Suspecting an endocrine disorder her doctor orders biochemical testing. Results are shown below 8am cortisol: 45 ug/dL (10-20 ug/dL) AM ACTH: 80 pg/mL (9-63 pg/mL) 24 hr urine cortisol: 138 ug/day (6-42 ug/day) FSH: 5.8 (3-8 mIU/mL) LH: 4.9 (1.8-11.78 mlU/mL) Estradiol (estrogen) 21 (18-147 pg/mL) Testosterone: 420 ng/dL (20-80 ng/dL) a. What is the likely diagnosis? b. What is the biochemical reasoning behind the diagnosis? Use the test results to explain c. Is this a primary, secondary or tertiary endocrine disorder? How do the biochemical test results help explain the origin? d. Explain a biochemical/imaging test that can be used to confirm this disorder e. What is the correlation between the cortisol and testosterone measurement and the symptoms of virlization seen in this woman?

Answer 1

a - Polycystic Ovary Syndrome

b - high testosterone level which is primarily a Male hormone or androgen and high AM ACTH level , is seen mostly in PCOS.In some case high cortisol level is also seen.Cortisol will be deregulated in PCOS, enhanced cortisol secretion. Increased ACTH secretion could also lead to elevated adrenal.androgen production.

In this case also these 3 hormones are high.

c - this is small secondary endocrine disorder, since secondary disorder is due to under stimulation or overstimulation of pituitary.

d - Ultrasonography of abdomen pelvis

e - enhanced cortisol level will increase adrenal androgen production.

Virilization means a condition where women develop male pattern characteristics due to testosterone hormone.In this case, women develop increased hair growth.