261
Chapter 20 Hirsutism and Virilisation
S
E
C
T
I
O
N
IV
Illustrative Cases
Case 1
An 18-year-ROG PHGLFDO VWXGHQW SUHVHQWV ZLWK
\HDU KLVWRU\ RI ZHLJKW JDLQ DQG LUUHJXODU F\FOHV DQG
LQFUHDVHG KDLU JURZWK RQ WKH IDFH DQG DUPV 6KH LV
IRUFHG WR VKDYH RQFH LQ ZHHNV 7KHUH LV QR IDPLO\
history of similar problems.
:KDW FOLQLFDO IHDWXUHV ZLOO \RX ORRN IRU"
1.
:KDW LV \RXU SURYLVLRQDO GLDJQRVLV"
2.
What investiJDWLRQV ZLOO \RX RUGHU"
+RZ ZLOO \RX PDQDJH"
Case 2
$ \HDU ROG JLUO SUHVHQWV ZLWK KLVWRU\ RI LQFUHDVHG
KDLU JURZWK RI \HDUV· GXUDWLRQ 7KHUH LV QR PHQ-
VWUXDO LUUHJXODULW\ %0, LV 0RWKHU DQG VLVWHU KDYH
VLPLODU KLVWRU\ 6KH XVHV GHSLODWRU\ FUHDP HYHU\
² ZHHNV
:KDW FOLQLFDO IHDWXUHV ZLOO \RX ORRN IRU"
1.
:KDW LV \RXU SURYLVLRQDO GLDJQRVLV"
2.
:KDW LQYHVWLJDWLRQV ZLOO \RX RUGHU"
+RZ ZLOO \RX PDQDJH"
Answers
Case 1
%0, EORRG SUHVVXUH H[WHQW RI KLUVXWLVP )HU-
1.
ULPDQ²*DOOZH\ VFRUH VLJQV RI YLULOLVDWLRQ³FOL-
WRURPHJDO\ IURQWDO EDOGLQJ EUHDVW H[DPLQDWLRQ
DEGRPLQDO H[DPLQDWLRQ IRU VWULDH
3&26 UXOH RXW /2+'
2.
D ,I WKHUH LV QR YLULOLVDWLRQ DQG KLUVXWLVP LV PLOG
to moderate
L &RQÀUP 3&26
LL 6HUXP )6+ /+ UDWLR
(iii) Ultrasound scan to look for polycystic
ovaries
LY %ORRG WHVWV³VXJDU OHYHO OLSLG SURÀOH
E ,I FOLWRURPHJDO\ LV SUHVHQW DQG KLUVXWLVP LV
moderate to severe, consider
(i) LOHD
LL 6HUXP '+($ DQG
A
K\GUR[\
progesterone
,I GLDJQRVLV LV 3&26
(a) Weight reduction
(b) Combination OC pills
,I GLDJQRVLV LV /2&+' GH[DPHWKDVRQH
Case 2
6HYHULW\ RI KLUVXWLVP )* VFRUH EUHDVW H[DPLQD-
1.
tion, signs of virilisation
,GLRSDWKLF KLUVXWLVP
2.
,I QR RWKHU FOLQLFDO DEQRUPDOLW\ GHWHFWHG QR LQ-
vestigations are required
6LQFH KLUVXWLVP LV PRGHUDWH DQG QHHGV KDLU UHPRY-
DO JLYH VSLURQRODFWRQH PJ GDLO\ HÁRUQLWKLQH
cream for facial application daily
(or)
Laser therapy
Sample Questions
Long-Answer Question
$Q \HDU ROG JLUO SUHVHQWV ZLWK KLUVXWLVP +RZ
1.
ZLOO \RX HYDOXDWH" 'LVFXVV WKH PDQDJHPHQW
Short Notes
Virilisation
1.
Androgen-secreting tumours of the ovary
2.
/DWH RQVHW
K\GUR[\ODVH GHÀFLHQF\
Medical management of hirsutism
