interesting question

[dmitrio]

A 55-year-old woman complains of seborrhea, acne, and mild facial hirsutism since menopause 2 years ago. Her serum androstenedione and estrone levels are moderately elevated. Which of the following is the most likely cause of her condition?

a. Amount of body fat
b. Increased ovarian steroid secretion
c. Increased adrenal steroid secretion
d. Diminished renal steroid elimination
e. Diminished hepatic steroid clearance












































The answer is b. (Speroff, 6/e, pp 658-662.) Peripheral conversion of androstenedione to estrone in the fat tissue is the major source of estrogens in the menopausal woman. The conversion rate and the resulting estrogen levels are dependent on the percentage of body fat and increase as women age. In obese women, higher estrone levels will be found and the menopausal symptoms will be less frequent. These women are also less likely to develop osteoporosis. Especially in obese postmenopausal women, this prolonged and unopposed estrogen stimulation may cause uterine bleeding, endometrial hyperplasia, and adenocarcinoma.

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This question is unclear to me.
How is elevation of androstenedione can have ovarian origin?
Question stem gives elevation of estrogen, as well, so level of LH/FSH would be slightly declined and would subsequntly decrease level of androstendione, is not?

[lipsar]

Hey--I have an issue, not with the question, but with your signature line. LSD was not invented in Berkeley; it was invented in Switzerland by Albert Hoffman. And early in menopause FSH levels are actually elevated.

[dmitrio]

Originally Posted by lipsar

Hey--I have an issue, not with the question, but with your signature line. LSD was not invented in Berkeley; it was invented in Switzerland by Albert Hoffman. And early in menopause FSH levels are actually elevated.

Tnx for pointing out about LSD origin

Back to the Q.
The Pt is already have estrogen level elevated - so IMO FSH should not be elevated.
However, I agree with you that FSH elevated in early menopause.