Kali Rani, a 20-year-old girl presents with history of rapidly developing hirsutism and amenorrhea. To establish the diagnosis you would like to proceed with which of the following tests in blood:
Ans. is c, i.e. TestosteroneRef: Dutta Gynae 4th/ed, p524; Leon Speroff 7th/ed, p502-511,515; Williams Gynae 1st/ed, p391"A variety of ovarian neoplasms, both benign and malignant may produce testosterone and lead to virilization. Specifically, women with an abrupt onset, typically within several months, or sudden worsening of virilizing 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 five testosterone assays lack a uniform laboratory standard. For this reason, total testostrerone levels remain the best approach for excluding a tumor. Threshold values beyond 200ng/dl of total testosterone warrant evaluation for an ovarian leison." - Williams Gynae 1st/ed, p391Testosterone estimation is the best investigation in case of rapid onset hirsutism and amennorhea.Lines of Leon Speroff further support the answer --"A serum testosterone concentration greater than 150mg/dl identifies almost all woman with a potential androgen producing tumor. However, a tumor still should be suspected and excluded in a woman with rapidly progressive hirsutism or signs and symptoms of virilization, even when the serum testosterone concentration is below the threshold value." - Leon Speroff 8th/ed, p52* M/C cause of rapid onset hirsutism in young females = Testosterone producing tumorDHEA sulphate is produced exclusively by the adrenal gland. Therefore, serum DHEAS levels above 700mcg/dl are highly sensitive for the presence of an adrenal neoplasm.Adrenal imaging with abdominal CT or MRI is indicated for any patient with DHEAS levels that exceed this value.
17 - OH progesterone
DHEA
Testosterone
LH :FSH ratio
Disorders in Menstruation