A 14 years old girl came to the endocrinology clinic for evaluation of menstrual irregularity. Her body weight was 132 pounds. She has velvety dark colored patches over the nape of her neck and the flexor creases. Apart from menstrual irregularity she also complained of hair growth over her upper lip.

1. The Following facts about her upper lip hair is true

(a) It is scientifically referred to as hypertrichosis

(c) This conditions represents an absolute estrogen deficiency state

(d) In a large majority this condition is idiopathic.

Answer: The answer is (b). Hirsutism must be distinguished from hypertrichosis, the generalized excess growth of hair that occurs in subjects taking glucocorticoids, phenytoins, diazoxide, or cyclosporine and that sometimes occurs on a hereditary basis. Hypertrichosis is distributed in a nonsexual pattern (eg, in a generalized distribution or more prominent on the forehead or shoulders) and is not caused by excess androgen, although it may be aggravated by excess androgen. Hirsutism is graded according to the Ferriman-Gallwey system; a score of less than eight is normal in adults. Hirsutism represents an androgen excess state or a relative estrogen deficiency state. This condition can be idiopathic in a small minority of patients.

2.  The single most important treatment for her menstrual irregularity is

(a) Oral Contraceptive pills

(b) Anti androgen pills

(c) Metformin

(d) Weight reduction.

Answer: The answer is (d). The single most important factor which can correct the menstrual abnormalities in PCOS is weight reduction. Metformin reduces insulin resistance and OCPs help to regularize the periods.

3. The velvety dark colored patches over the nape of her neck indicate

(a) Insulin resistance

(b) Imbalance between estrogen and progesterone

(c) Imbalance between LH and FSH

(d) Imbalance between melanin stimulating hormone and ACTH.

Answer: The answer is (a). Acanthosis nigricans which is the condition described here is a marker of insulin resistance. Patients with the greatest degree of insulin resistance also may have pseudoacromegaly with overgrowth in height and prognathism (projection of the jaw).

4. Hyperandrogenemia in adult women is expressed as all the following except:

(a) Male pattern of hair distribution

(b) Male pattern of baldness

(c) Seborrheic dermatitis.

(d) Regression of breast tissue.

Answer: The answer is (c). Hyperandrogenemia should be considered in those with severe acne of sudden onset or conspicuous male-pattern baldness with hairline recession. Hirsutism or male pattern hair distribution also indicates hyperandrogenemia. Regression of breast tissue is also due to excess androgen in the circulation.

5. The risk from anovulatory cycles associated with Polycystic Ovarian Syndrome include

(a) endometrial cancer

(b) ovarian cancer

(c) Type 2 diabetes

(d) Heart Disease

Answer: The answer is (a). Though polycystic ovarian syndrome is associated with the risk of type 2 diabetes and coronary artery disease later in life, the abnormality associated with anovulatory cycles include endometrial hyperplasia and carcinoma.