### Date : 2024-06-23 10:25 ### Topic : Hyperandrogenism #medicine #endocrinology ---- ### Hyperandrogenism Overview **Hyperandrogenism** refers to a condition characterized by excessive levels of androgens (male hormones such as testosterone) in the female body. Androgens are typically present in women in small amounts, but elevated levels can lead to various physical symptoms and health issues. ### Causes Hyperandrogenism can be caused by several conditions, including: 1. **Polycystic Ovary Syndrome (PCOS):** - The most common cause of hyperandrogenism in women. - Characterized by irregular menstrual periods, ovarian cysts, and elevated androgen levels. 2. **Congenital Adrenal Hyperplasia (CAH):** - A genetic disorder affecting the adrenal glands, leading to excess production of androgens. - Can present in varying degrees, from mild to severe forms. 3. **Androgen-secreting Tumors:** - Tumors of the ovaries or adrenal glands can produce androgens. - These tumors are rare but can cause significant hyperandrogenism. 4. **Cushing's Syndrome:** - A condition where there is excessive production of cortisol, which can increase androgen levels. - Often caused by long-term use of corticosteroids or tumors of the adrenal gland or pituitary gland. 5. **Idiopathic Hyperandrogenism:** - Elevated androgen levels without an identifiable cause. ### Symptoms The symptoms of hyperandrogenism can vary in severity and may include: - **Hirsutism:** Excessive hair growth in areas where men typically grow hair, such as the face, chest, and back. - **Acne:** Severe and persistent acne, often resistant to typical treatments. - **Alopecia:** Thinning hair or male-pattern baldness. - **Menstrual Irregularities:** Irregular or absent menstrual periods. - **Deepening Voice:** A lower-pitched voice due to vocal cord thickening. - **Increased Muscle Mass:** Unusual increase in muscle mass. - **Clitoromegaly:** Enlargement of the clitoris (in severe cases). ### Diagnosis **Clinical Evaluation:** - Detailed medical history, including menstrual history and family history of related conditions. - Physical examination to assess signs of hyperandrogenism, such as hirsutism, acne, and alopecia. **Laboratory Tests:** - **Serum Androgens:** Measurement of testosterone, DHEA-S (dehydroepiandrosterone sulfate), and androstenedione levels. - **Other Hormonal Tests:** Assessing levels of LH (luteinizing hormone), FSH (follicle-stimulating hormone), prolactin, and cortisol to evaluate for conditions like PCOS, CAH, or Cushing's syndrome. **Imaging Studies:** - **Pelvic Ultrasound:** To assess for ovarian cysts indicative of PCOS. - **CT Scan or MRI:** To identify adrenal or ovarian tumors. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 25 - **Occupation:** Student **Medical History:** - Irregular menstrual periods, severe acne, and increased facial hair growth over the past year. No significant family history of similar symptoms. **Clinical Evaluation:** - Physical examination reveals hirsutism on the face and chest, moderate acne, and mild alopecia. **Laboratory Tests:** - Elevated serum testosterone and DHEA-S levels. - LH/FSH ratio suggestive of PCOS. **Imaging Studies:** - Pelvic ultrasound shows multiple small ovarian cysts. **Diagnosis:** Based on clinical presentation, laboratory results, and imaging findings, Jee Hoon Ju is diagnosed with polycystic ovary syndrome (PCOS)-related hyperandrogenism. ### Management 1. **Lifestyle Modifications:** - **Weight Management:** Diet and exercise to reduce insulin resistance and improve hormonal balance. - **Healthy Diet:** Low glycemic index foods, reduced refined carbohydrates, and increased fiber intake. 2. **Medications:** - **Oral Contraceptives:** To regulate menstrual cycles and reduce androgen levels. - **Anti-Androgens:** Spironolactone or finasteride to block androgen effects and reduce symptoms like hirsutism and acne. - **Metformin:** To improve insulin sensitivity, particularly in women with PCOS. - **Topical Treatments:** Eflornithine cream to reduce facial hair growth. 3. **Procedural Treatments:** - **Laser Hair Removal or Electrolysis:** For long-term hair reduction. - **Dermatological Treatments:** For managing acne, such as topical retinoids or antibiotics. 4. **Surgical Treatment:** - **Ovarian Surgery:** In rare cases, laparoscopic ovarian drilling can be considered for PCOS if other treatments fail. - **Tumor Removal:** Surgical removal of androgen-secreting tumors if identified. ### Prognosis - **PCOS-Related Hyperandrogenism:** Can be managed effectively with lifestyle changes and medications, improving quality of life and reducing long-term health risks. - **Tumor-Related Hyperandrogenism:** Surgical removal of tumors generally leads to resolution of symptoms. - **Congenital Adrenal Hyperplasia:** Lifelong management with medications is often necessary. ### Conclusion Hyperandrogenism is a condition characterized by elevated levels of androgens in women, leading to various symptoms such as hirsutism, acne, and menstrual irregularities. It can be caused by conditions like PCOS, CAH, and androgen-secreting tumors. Diagnosis involves clinical evaluation, laboratory tests, and imaging studies. Management includes lifestyle modifications, medications, procedural treatments, and, in some cases, surgery. Effective management can significantly improve symptoms and quality of life for affected individuals.