Gynaecological endocrinology: virilisation with raised adrenal androgen: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological endocrinology: virilisation with raised adrenal androgen

Sample item

A 30-year-old has rapidly progressive hirsutism and voice deepening over 5 months. Total testosterone and serum DHEAS are both markedly raised, and both ovaries look normal on transvaginal ultrasound. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. CT or MRI of the adrenal glands

Rapid virilisation with very high testosterone suggests a tumour. A markedly raised DHEAS points to an adrenal source, so adrenal imaging is needed. Ovarian causes would show raised testosterone with normal DHEAS and usually an adnexal mass.

Option by option

  • A. Start spironolactone and review

    Spironolactone controls mild hirsutism and would delay diagnosis of a tumour.

  • B. Bilateral oophorectomy

    Oophorectomy is not justified when the ovaries are normal on imaging.

  • C. Laparoscopic ovarian drilling

    Ovarian drilling treats PCOS and does not address an androgen-secreting tumour.

  • D. CT or MRI of the adrenal glands (correct)

    Correct. Markedly raised DHEAS with normal ovaries points to an adrenal androgen-secreting tumour.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, CT or MRI of the adrenal glands. Rapid virilisation with very high testosterone suggests a tumour.

Why is "Start spironolactone and review" not the answer?

Spironolactone controls mild hirsutism and would delay diagnosis of a tumour.

Why is "Bilateral oophorectomy" not the answer?

Oophorectomy is not justified when the ovaries are normal on imaging.

Why is "Laparoscopic ovarian drilling" not the answer?

Ovarian drilling treats PCOS and does not address an androgen-secreting tumour.

What concept does this question test?

It tests Gynaecological endocrinology: virilisation with raised adrenal androgen in OBG. A markedly raised DHEAS points to an adrenal source, so adrenal imaging is needed. Ovarian causes would show raised testosterone with normal DHEAS and usually an adnexal mass.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology: virilisation with raised adrenal androgen?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.