Obesity Hyperoestrogenaemia — RACP Adult Medicine MCQ
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Correct answer: C — Increased peripheral aromatisation of androgens plus impaired hepatic metabolism of oestrogens
The best answer is “Increased peripheral aromatisation of androgens plus impaired hepatic metabolism of oestrogens”. Adipose aromatase converts androgens to oestrogens, and chronic liver disease reduces metabolism of circulating sex steroids and alters binding proteins. Together these shift the oestrogen-androgen balance toward breast stimulation. The alternatives reverse the relevant pathways or invoke hormonal abnormalities that do not explain this combined phenotype.
Reference: Australian Diabetes Society: Australian type 2 diabetes glycaemic management algorithm: https://www.diabetessociety.com.au/guideline/australian-t2d-glycaemic-management-algorithm-june-2024/