Friday, March 27, 2009


A 32 year old female came with amenorrhea , hirsutism (facial hair) and obesity

a.Give two causes of above complaints.

  • Increase cortisol in blood (hypercortisolism)
  • Increase prolactin in blood (hyperprolactinemia)

b. State 3 investigation that you would like to do and give reason

  • Dexamethasone suppression test

To check the cause of high cortisol , weather it is ACTH dependent or not.

  • Skull x-ray

Can visualize if there is pituitary gland adenoma

  • Blood test to measure prolaction and cortisol level in blood

High cortisol and prolactin will give rise to above symptoms

On physical examination

Pulse rate : 80 beats/min

Blood Pressure : 150/90 mmHg

There is echymosis.

Dexamethasone test also done.

c.Principal of dexamethasone test

  • It has two types, low dose and high dose. Patient will be inject with exogenous steroid (dexamethasone), in low dose-1-2mg and hig dose-8mg. To get the result cortisol level will be measured. A normal result is decrease in cortisol levels upon administration of low-dose dexamethasone.

d.Give the diagnosis

  • Pituitary adenoma (which secrete ACTH and Prolactin)

e. Explain pathophysiology of each sign and symptoms in this patient

  • hyperprolactinemia-Inhibit effect of gonadotrophin releasing hormone (GnRH) on sex organ-No LH and no FSH-no ovulation and follicular development-amenorrhea
  • hypercosticolism-increase fat metabolism-fat redistribution-fat deposited on face , trunk and at the back-obesity
  • hypercorticolism-reduce fibroblast activity and collagen synthesis-thin skin-easily bruise-ecchymosis


1.In Cushing dz, no change in cortisol on low-dose dexamethasone, but inhibition of cortisol on high-dose dexamethasone. If the cortisol levels are unchanged by low- and high-dose dexamethasone then other causes of Cushing's Syndrome must be considered. In ectopic ACTH secretion (paraneoplastic syndrome), ACTH level will be high even in high dose of dexamethasone.

2.Normally prolactin is inhibited by PIF (dopamine secreted by hypothalamus).

3.Physiologically high prolactin occur in lactation which also will cause amenorrhea.

~living well or living hell? Fighting for future!~


Ibnu Shaukani on March 6, 2009 at 11:11 PM said...

apa cause of hirsutism? =P

Miss Independent on March 6, 2009 at 11:22 PM said...

pkck, kan smlm saya tnya kamu, maksudnyer saya tatau la. hoho!

anyone pliz answer dia ques ya. arigatou~

Miss Independent on March 7, 2009 at 1:41 AM said...

found some explanation but dunno weather it will help or will confusing u all..huhu

hirsutim ni disebabkan oleh high androgen (free testosterone). dlm blood testosterone wujud dlm dua jenis, either free (active) or bind to sex hormone binding globulin (SHBG), kalo bind ni tader effect pd cells.

in Cushing disease, somehow the level of SHBG is decrease (jgn tnya kenapa, saya pon tatau). low SHBG will lead to relatively high free testosterone, so ada la hirsutism.

Jacknaim on March 7, 2009 at 2:17 PM said...

actually dalam kes ni pon bleh diagnose polycsytic ovarian syndrome jugak.. abdominal ultrasound can be helpful.

disebabkan oleh increase ovarian androgen production.

androgen ada growth promoting effect pada hair follicle...

hazirah on May 14, 2009 at 12:51 PM said...

dlm Cushing's syndrome, hypercortisolism will also increase androgen production as a synergistic effect..
high androgen will surpress LH secretion in female leading to amenorrhea, hirsutism, infertility and acne formation.
as for male..high androgen will surpress testosterone leading to loss of libido, loss of body hair, small and soft testes and also impotence..
Sila rujuk Lange Pathophysio utk keterangan lanjut..


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