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diagnosis algorithm differential endocrinology adrenalmass causes hirsutism 17bhydroxysteroid addisons adrenal aldosterone alopecia amenorrhea androstenedione aromatase benign corticosterone cortisol dehydroepiandrosterone dehydrogenase
ACTH LH Cholesterol cholesterol desmolase Pregnenolone 17a-hydroxylase 17 Hydroxyregnenolone 17,20-lyase 3B-hydroxysteroid dehydrogenase 3B-hydroxysteroid dehydrogenase 17a-hydroxylase #Progesterone 17-Hydroxyprogesterone 17,20-lyase 21ß-hydroxylase 21ß-hydroxylase 11-Deoxycorticosterone 11-Deoxycortisol 11ß-hydroxylase 11ß-hydroxylase #Cortisol #Dehydroepiandrosterone #DHEA 3ß-hydroxysteroid dehydrogenase 个 #Androstenedione #17B-hydroxysteroid #dehydrogenase #Testosterone #aromatase #FSH #Estradiol #5a reductase #Corticosterone aldosterone synthase #Aldosterone Angiotensin || #Dihydrotestosterone (DHT)
Dehydroepiandrosterone #DHEA ... #Estradiol #5a
Steroid Synthesis Pathway (OH, hydroxy; HSD, hydroxysteroid dehydrogenase; DHEA, dehydroepiandrosterone; pink, common enzymes affecting CAH, purple –
dehydrogenase; DHEA
A diagnostic approach to secondary amenorrhea. (DHEA-S = dehydroepiandrosterone sulfate; FSH = follicle-stimulating hormone; LH =
(DHEA-S = dehydroepiandrosterone
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 Benign Adrenal Mass - Differential Diagnosis Algorithm Hyperplasia - Often Bilateral • Congenital Adrenal Hyperplasia • ACTH
Hirsutism • High DHEAS ... • Low DHEAS ... Mass • Normal DHEAS
Hirsutism & Virilization - Differential Diagnosis Algorithm ADRENAL EXCESS Ovarian • Polycystic Ovarian Syndrome • Hyperthecosis • Tumor Adrenal
• Testosterone DHEA
Malignant Adrenal Mass - Differential Diagnosis Algorithm Suggestive of Malignancy: Inhomogenous Density, Delay in CT Contrast Washout
Hirsutism • High DHEAS ... Carcinoma) • Normal DHEAS
Primary Adrenal Insufficiency Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and
present) ↓ DHEA ... Labs: ↓ Serum DHEAS
Hirsutism - Differential Diagnosis Algorithm RAPID ONSET Medications • Steroids • Danazol • Progestin Containing Contraceptives Increased Serum Testosterone
Increased Serum DHEAS
Prescription Fish Oils Prescription fish oils, Lovaza, and Vascepa, are commonly used for treatment of hypertriglyceridemia (TG
LDL due to the DHA
Allopecia - Differential Diagnosis Framework for Hair Loss Localized / Focal Hair Loss Pattern: • Scarring Alopecia:
Prolactin, FSH, LH, DHEAS
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