In 16 years old girl presents with rapid onset hirsutism and amenorrhea is best evaluated by -
Ans-A Testosterone (Ref Harrison, II/e, p 277, 2205 (15th/e, p. 299-300)).Come on, don 7 think I am not aware of LH and FSH estimation. Read below taking into consideration that this patient has rapid onset hirsutism.Let us see what Harrison has to say about rapid onset hirsutism " Sudden development and rapid onset of hirsutism suggest the possibility of an androgen-secreting neoplasm."So this patient is not suffering from PCOD.Androgen can be secreted by both the ovaries and adrenal neoplasm.The principal circulating steroids involved in the etiology of hirsutism are -AndrostenedioneDehydroepiandrosteroneDHEAS andTestosteroneNow the confusion is which is the most important one. Most of the students believe that it is dehydroepiandrosterone, But in Harrison, it is clearly given that Testosterone is the most important androgen mediating Hirsutism. Read the following lines from Harrison and you will agree with me "Although it is the most important circulating androgen, testosterone is in effect the penultimate androgen in mediating hirsutism."It is the penultimate androgen because testosterone is first converted to more potent dihydrotestosterone, which then acts on androgen receptors.Go through Fig. 53.2 on page 300 of Harrison 15th/e. It will help you to understand this question in a better way.
Tetosterone estimation
Dehydroepiandrosterone
Adenocorticoidy
LH and FSH estimation