Question 1
Which of the following features is NOT seen in hyperandrogenism?
(A) Raised haematocrit
(B) Androgenetic alopecia
(C) Post-menopausal bleeding
(D) Hirsuitism
(E) Thrombocytocis
E: Raised haematocrit occurs as a result of testosterones downregulation of hepcidin. Circulating angrogens trigger the synthesis of hair but also supresses the growth of hair on the scalp, which is known as male-pattern baldness, or androgenetic alopecia. Abnormal uterine bleeding occurs because the circulating testosterones are converted to oestrogens, triggering endometrial hyperplasia. Endometrial hyperplasia without concomitant progesterone will cause abnormal bleeding. N Engl J Med 2015; 373:1660-1666
Question 2
A 17 year old female presents with failure to menstruate. She has never had a period. There is no history of anosmia, although there is a history of bilateral inguinal hernias. She has absent pubic and axillary hair however her breast development is normal. Her height is also normal for her age. There is no sign of intellectual impairment. What is the most likely diagnosis?
(A) Kallmans syndrome
(B) Klinefelters syndrome
(C) Androgen insensitivity syndrome
(D) Turners syndrome
(E) Asherman's syndrome
C: Kallmans syndrome occurs due to failure of development of the olfactory bulb. Anosmia is a predominant component. The presence of breast development in the absence of secondary sexual hair, with a history of hernias as a child is suggestive of a diagnosis of androgen insensitivity syndrome. It is likely that the hernias were related to undescended testes. The vagina is blind ended, and there are no ovaries.
Which of the following features is NOT seen in hyperandrogenism?
(A) Raised haematocrit
(B) Androgenetic alopecia
(C) Post-menopausal bleeding
(D) Hirsuitism
(E) Thrombocytocis
E: Raised haematocrit occurs as a result of testosterones downregulation of hepcidin. Circulating angrogens trigger the synthesis of hair but also supresses the growth of hair on the scalp, which is known as male-pattern baldness, or androgenetic alopecia. Abnormal uterine bleeding occurs because the circulating testosterones are converted to oestrogens, triggering endometrial hyperplasia. Endometrial hyperplasia without concomitant progesterone will cause abnormal bleeding. N Engl J Med 2015; 373:1660-1666
Question 2
A 17 year old female presents with failure to menstruate. She has never had a period. There is no history of anosmia, although there is a history of bilateral inguinal hernias. She has absent pubic and axillary hair however her breast development is normal. Her height is also normal for her age. There is no sign of intellectual impairment. What is the most likely diagnosis?
(A) Kallmans syndrome
(B) Klinefelters syndrome
(C) Androgen insensitivity syndrome
(D) Turners syndrome
(E) Asherman's syndrome
C: Kallmans syndrome occurs due to failure of development of the olfactory bulb. Anosmia is a predominant component. The presence of breast development in the absence of secondary sexual hair, with a history of hernias as a child is suggestive of a diagnosis of androgen insensitivity syndrome. It is likely that the hernias were related to undescended testes. The vagina is blind ended, and there are no ovaries.
