16 years old girl presents with rapid onset hirsutism and amenorrhea. Best investigation is :
Ans. is a i.e. Testosterone estimation "A variety of ovarian neoplasms, both benign and malignant may produce testosterone and lead to virilisation. Specifically, women with an abrupt onset, typically within several months, or sudden worsening of virilising signs should prompt concern for a hormone producing ovarian or adrenal tumor. Symptoms may include deepening of voice, frontal balding, severe acne or hirsutism or both, increased muscle mass and clitoromegaly. Accordingly, serum testosterone levels may be used to exclude these tumors. Free testosterone levels are more sensitive than total testosterone levels as an indicator of hyperandrogenism. Although improving, current free testosterone assays lack a uniform laboratory standard. For this reason. total testostrerone levels remain the best approach for excluding a tumor. Threshold values beyond 200 ng / dl of total testosterone warrant evaluation for an ovarian leison." So now I do not need to explain that testosterone estimation is the best investigation in case of rapid onset hirsutism and amennorhea. Also know : Other investigations to be done in an Anovulatory hirsute female: -- Serum 170H progesterone levels (to rule out congenital adrenal hyperplasia). Serum TSH -- Serum Prolactin -- Insulin (as hyper insulinemia leads to hirsutism) -- 24 hour urinary free coisol excretion and evening plasma coisol level (to rule out cushing syndrome). -- LH/FSH ratio (for diagnosing PCOS).
Testosterone estimation
Dihydroepiandrosterone
Adrenocoicoids
LH and FSH estimation