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Author20 Posts
  #1

A 32-yr old woman has a 3 yr his of oligomenorrhea that has progressed to amenorrhea during the past yr. She has observed loss of breast fullness, reduced hip measurements, acne, increased body hair, and deepening of her voice. P/E reveals frontal balding, clitoral hypertrophy, and a male escutcheon. Urinary free cortisol and DHEAS are normal. Her plasma testerone level is 6 ng/ml. The most likely diagnosis is:

a. Cushing's syn
b. Arrhenoblastoma
c. Polycytic ovary syndrome
d. Granulosa-theca cell tumor




  #2

C.


  #3

try again?


  #4

A


  #5

A


  #6

A


  #7

answer is b. key: differentiation of hirsutism and virilization. a and c are the causes of hirsutism.


  #8

I did not have any clue wat arrhenoblastoma is.
Found it on the internet.I thought I shud share just incase someone else is wondering (like me) wat is it? :?:
Alternative names
Stromal tumor; Gonadal stromal tumor; Sex cord tumor; Androblastoma
Definition
Arrhenoblastoma of the ovary is an ovarian tumor that secretes testosterone.
Causes, incidence, and risk factors
This is a rare tumor that accounts for less than 0.5% of all ovarian tumors. These tumors are found in women of all age groups, but are most common in young women.
Symptoms
This tumor secretes male hormones which causes secondary sex changes in women including:
deepening of the voice
increased facial and body hair
increased size of the clitoris
male pattern baldness
Signs and tests
ultrasound of the ovaries
CT scan of pelvis and abdomen to look for tumor spread
blood tests to check levels of hormones which may be secreted by the tumor
Treatment
Surgery is the main treatment. If the cancer has spread, chemotherapy or radiation therapy should be considered


  #9

it is an ovarian tumor, but did not read this one in step1. Anyway, this point is mentioned in both Secrets and Pretest, so it is worth to know.


  #10

good job Hamidi, thanks!


  #11

Very nice Hamid! :lol: Keep going!


  #12

"icecool" wrote:
A 32-yr old woman has a 3 yr his of oligomenorrhea that has progressed to amenorrhea during the past yr. She has observed loss of breast fullness, reduced hip measurements, acne, increased body hair, and deepening of her voice. P/E reveals frontal balding, clitoral hypertrophy, and a male escutcheon. Urinary free cortisol and DHEAS are normal. Her plasma testerone level is 6 ng/ml. The most likely diagnosis is:

a. Cushing's syn
b. Arrhenoblastoma
c. Polycytic ovary syndrome
d. Granulosa-theca cell tumor

Nice work by Hamidi but I am wondering the level of testerone level is 6 ng/ml I think it is very low for this tumor what I remeber from my clinical practice. icecool can you check it again for me :?: Thanks


  #13

good job hamidi grin


  #14

To SA,
The q is from Pretest, it is indeed 6 ng/ml (normal: 0.2~point eight, sorry I have a problem with "8" key!!). What is your exp? thanks!


  #15

HI

well done hamidi

i did look for choice b
but was confused cuz i was not getting proper info


thanks for ur info


  #16

Welcome.I knew it wasn't A,C &D but did not know wat exactly is B.All I did was search on google.Life is much easier with internet. grin


  #17

"icecool" wrote:
To SA,
The q is from Pretest, it is indeed 6 ng/ml (normal: 0.2~point eight, sorry I have a problem with "8" key!!). What is your exp? thanks!

it should be something in 100s please check it again I am also checking and will post the refrence if I find one.


  #18

I think it is free testosteron leve(n 0.7-3.6pg/ml in females)not the testosterone levelwhich is6-86 ng/dl in females.just a guess


  #19

Hi, SA,

The original ref is "Fauci, 14/e, p20" Pretest-Medicine. The following cited is from a web article:

"If the serum testosterone is greater than 200 ng/dL, or free testosterone is greater than 40ng/dL, or the androstenedione is greater than 1000 ng/dL, pelvic exam and Ultrasound may be performed to look for ovarian cancer. If the Ultrasound is negative, a CT scan of the adrenal glands is performed to look for adrenal cancer."

I think this is in agreement with the q (> 2 ng/ml --->consider ovarian cancer). Many articles did not give the exact value, but if I found good ones, I will post them later. Good work everybody, we are doing research here!

Another point I would add is: signs are the key for making diagnosis of arrhenoblastoma.

May be we can ask a q this way: what signs found in this pt can also be seen in a pt with hirsutism?


  #20

good info guys

keep it up :lol:





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