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androgen excess (hyperandrogenism)

Etiology: - postmenopausal hyperandrogenism - functional hyperandrogenism - polycystic ovary syndrome - congenital adrenal hyperplasia - ovarian hyperthecosis - Cushing's syndrome - acromegaly - exposure to exogenous testosterone or DHEA - tumor-associated hyperandrogenism - adrenal adenoma, adrenal carcinoma (androgen secreting)* - ovarian neoplasm (androgen secreting)* - metastatic neuroendocrine tumor * androgen-secreting ovarian tumors are uncommon among ovarian tumors but much more common than androgen-secreting adrenal tumors [1] * markedly elevated serum DHEA-sulfate makes adrenal neoplasm more likely than ovarian neoplasm [2] Clinical manifestations: 1) disorders of the pilosebaceous unit a) acne b) hirsutism c) alopecia d) virilization 2) ovulatory dysfunction a) amenorrhea b) female infertility 3) emotional lability 4) excessive muscle bulk 5) small testes, testicular atrophy 6) gynecomastia 7) diminished spermatogenesis & male infertility 8) hypogonadotropic hypogonadism Laboratory: - serum testosterone elevated - serum free testosterone elevated - serum DHEA may be normal if testosterone is elevated Radiology: - pelvic ultrasound to evaluate ovarian neoplasm - abdominal CT to evaluate adrenal neoplasm

Related

androgen or anabolic steroid

General

endocrine disease male genital disease

References

  1. McMahon GT, Bennett JA. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 33-2015. A 57-Year-Old Woman with Hair Loss and Deepening Voice. N Engl J Med. 2015 Oct 22;373(17):1660-6. PMID: 26488697
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022.
  3. Barbieri RL, Makris A, Randall RW et al Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab. 1986 May;62(5):904-10 PMID: 3514651
  4. Markopoulos MC, Kassi E, Alexandraki KI, Mastorakos G, Kaltsas G. Hyperandrogenism after menopause. Eur J Endocrinol. 2015 Feb;172(2):R79-91. Review. PMID: 25225480