A 6 years old girl came to the endocrinology out patient department for evaluation. Her mother noticed growth of pubic and axillary hair.

1.  The best predictor of polycystic ovarian syndrome in this girl would be

(a) Fasting blood sugar

(b) Fasting lipid profile

(c) Serum androstenedione

(d) Serum Dehydroepiandrosterone Sulphate.

Answer : The answer is (c). In one study of premature pubarche the best predictor of PCOS was an androstenedione concentration of greater than or equal to 87 ng/dL (3 nmol/L) at presentation in childhood. A dehydroepiandrosterone sulfate (DHEA sulfate) concentration of 75 µg/dL (2 µmol/L) was less discriminating. Androstenedione levels greater than 50 ng/dL (1.7 nmol/L) are distinctly unusual findings in premature adrenarche, suggesting that children with premature pubarche who are at risk of developing PCOS are atypical cases.

2.  All the following are reasons for her functional ovarian hyperandrogenism except

(a) Congenital Adrenal Hyperplasia

(b) Polycystic Ovarian Syndrome

(c) Testicular feminization syndrome

(d) Adrenal tumor.

Answer: The answer is (c). Functional ovarian hyperandrogenism is caused due to excessive androgen in circulation. This can be caused due to congenital adrenal hyperplasia, polycystic ovarian syndrome or adrenal tumor. In testicular feminization there is androgen insensitivity. Therefore there is no functional hyperandrogenism.