407.3 🩺 內科專科考前版

407.3.0.1 📌 䞀頁重點

  • 22E: ethnicity-specific Ferriman-Gallwey thresholds; ACTH stim test for borderline 17-OH-prog; AMH for PCOS confirmation; spironolactone safety in non-pregnant; eflornithine 13.9%
  • Taiwan: 健保 spironolactone, COC, dexamethasone, dexamethasone for CAH; eflornithine 自費 倚

407.3.0.2 🌟 Pearls (10)

  1. Asian / Taiwanese women lower Ferriman-Gallwey threshold (~ 5 may be abnormal vs 8 in white)
  2. Free T: more sensitive than total T in obesity (low SHBG)
  3. 17-OH-prog post-ACTH stim required if basal borderline (200-300 ng/dL)
  4. Spironolactone monitoring: K (especially with ACE-i/ARB combo), renal function
  5. Spironolactone slow onset: 6-12 mo for full hair benefit
  6. COC + spironolactone superior to either alone for hirsutism
  7. Finasteride 2.5-5 mg effective; lower dose may be sufficient
  8. Bicalutamide for refractory cases (off-label, less hepatotoxic than flutamide)
  9. Inositol + metformin for PCOS-related hirsutism (modest)
  10. Eflornithine 13.9% topical: 4-8 weeks for benefit; combine with mechanical removal

407.3.0.3 📍 Taiwan + 健保

  • 健保 spironolactone 倚 ($
  • 健保 COC (multiple types)
  • 健保 dexamethasone, hydrocortisone for CAH
  • 健保 finasteride (off-label hirsutism)
  • 健保 metformin
  • Eflornithine 13.9% cream 自費 倚
  • Cyproterone acetate 自費 (not approved Taiwan)
  • 健保 laser hair removal 條件 (selected; cosmetic generally not covered)
  • 健保 hormone panel + imaging workup

407.3.0.4 🎓 內專必懂 (10)

  1. Hirsutism workup algorithm + 排陀 tumor, CAH, Cushing’s
  2. Free T + DHEA-S + 17-OH-prog interpretation
  3. Tumor red flags + imaging
  4. Non-classic CAH diagnosis (basal + post-ACTH 17-OH-prog)
  5. PCOS-related hirsutism + comprehensive PCOS workup
  6. Spironolactone + COC combination + monitoring
  7. Pregnancy planning + anti-androgen contraindications
  8. Eflornithine + laser + electrolysis combined approach
  9. Idiopathic hirsutism + ethnicity adjustment
  10. 22E: AMH, free T sensitivity in obesity, bicalutamide, inositol

407.3.0.5 ⚙ Workup Algorithm (內專)

Step 1 — Confirm Hirsutism + Severity
- Ferriman-Gallwey scoring (ethnicity-adjusted)
- Distinguish from hypertrichosis (lanugo) and virilization

Step 2 — History + Exam
- Onset (gradual vs sudden)
- Drug history
- Menstrual pattern
- Cushing's signs
- Virilization

Step 3 — Hormone Panel
- Total T (or Free T if obese)
- DHEA-S
- 17-OH-progesterone (basal, AM, follicular phase)
- Prolactin
- TSH
- Cushing screening if symptomatic (1mg dex / 24h urine cortisol)
- HbA1c, lipid (PCOS metabolic)

Step 4 — Specific Tests
- 17-OH-prog basal 200-300 → ACTH stim test (suppress = normal; > 1000 = CAH)
- Free T calculated (with SHBG) if SHBG suspected abnormal
- Pelvic US (PCOS or ovarian tumor)
- Adrenal CT/MRI if T > 200 or DHEA-S > 700

Step 5 — Treatment
- Lifestyle for PCOS
- Mechanical hair removal (shaving/waxing/electrolysis/laser)
- Eflornithine cream (slow growth)
- Medical: COC + spironolactone
- Specific: HC for CAH, surgery for tumor, treat Cushing's

407.3.0.6 ⚙ Pregnancy + Hirsutism

  • Spironolactone: teratogenic (feminize male fetus) — stop pre-conception
  • Finasteride: teratogenic (genital malformation) — stop
  • Flutamide: teratogenic — stop
  • Cyproterone: teratogenic
  • COC: stop when planning conception
  • Metformin: continue if PCOS (improves cycle, no major teratogenic concern)
  • HC for CAH: continue (essential)
  • Lifestyle + mechanical hair removal safe

⚠ AI 草皿。