What is hyperandrogenism in women? Symptoms and treatment of hyperandrogenism

The pathological manifestation in a person of pronounced characteristic signs inherent in the opposite sex is often provoked by adrenal hyperandrogenism (adrenogenital syndrome). With the development of this syndrome, an increased content of androgens (steroidal male sex hormones) is observed in the body, leading to virilization.

General information

Virilization (masculinization) of adrenal origin is caused by excessive production of androgenic hormones by the adrenal glands and leads to external and internal changes that are atypical for the patient’s gender. Androgens are essential in the body adult woman, since they are responsible for important transformations of the body during puberty. In particular, they produce estrogen synthesis, and also help strengthen bone tissue, muscle growth, participate in the regulation of liver and kidney function, and the formation of the reproductive system. Androgens are produced mainly by the adrenal glands and in the female body by the ovaries, and in the male body, respectively, by the testicles. A significant excess of the normal levels of these hormones in women can significantly upset the reproductive system and even provoke infertility.

Causes of adrenal hyperandrogenism

Hormonal imbalance can trigger illness.

The main reason for the accumulation of androgens in the body is a congenital defect in the synthesis of enzymes, which prevents the conversion of steroids. Most often, this defect is caused by a deficiency of C21-hydroxylase, which synthesizes glucocorticoids. Besides, hormonal imbalance occurs as a consequence of the influence of hyperplasia of the adrenal cortex or tumor-like formations (some types of adrenal tumors are capable of producing hormones). The most common diagnosis is the presence of congenital adrenal hyperandrogenism. However, sometimes there are cases of the development of hyperandrogenism due to tumors of the adrenal glands that secrete androgens (Cushing's disease).

Pathogenesis

C21-hydroxylase deficiency can be successfully compensated for some time by the adrenal glands and enters a decompensated phase during stressful hormonal fluctuations, which are created by emotional shocks and changes in the reproductive system (onset of sexual relations, pregnancy). When the defect in enzyme synthesis becomes pronounced, the conversion of androgens to glucocorticoids stops and excess accumulation them in the body.

Features of the development of adrenogenital syndrome in women

Adrenogenital syndrome in women leads to major changes in the functioning of the ovaries and disorders in the reproductive system. According to statistical research, every fifth woman suffers from hyperandrogenism to one degree or another with various manifestations. Moreover, age does not matter in this case; the disease manifests itself at any stage life cycle, starting from infancy.

The effect of hyperandrogenism on ovarian function causes the following manifestations:

inhibition of growth and development of follicles in early phase folliculogenesis is manifested by amenorrhea (absence of menstruation for several cycles);
slowing down the growth and development of the follicle and egg, which is not capable of ovulation, can manifest itself as anovulation (lack of ovulation) and oligomenorrhea (increasing the interval between menstruation);
ovulation with defective yellow body, is expressed in insufficiency of the luteal phase of the cycle, even with regular menstruation.

Symptoms of adrenal hyperandrogenism

Facial hair in women increases with adrenal hyperandrogenism.

Adrenogenital syndrome has primary and secondary manifestations, depending on the phase of development of the disease and the factors of its occurrence. Indirect signs of the presence of adrenal hyperandrogenism in a woman are frequent colds, tendency to depression, increased fatigue.

The main symptoms of adrenal hyperandrogenism:

increased growth hairline(limbs, abdomen, mammary glands), up to hirsutism (hair growth on the cheeks);
baldness with the formation of bald patches (alopecia);
skin imperfections (acne, pimples, peeling and other inflammations);
muscle atrophy, osteoporosis.

The secondary symptoms of adrenogenital syndrome are the following:

arterial hypertension, manifested in the form of attacks;
elevated blood glucose levels (type 2 diabetes);
speed dial overweight, up to obesity requiring therapy;
intermediate type of formation of female genital organs;
absence of menstruation or significant intervals between menstruation;
infertility or miscarriage (for a successful pregnancy a certain amount of female hormones in the body, the production of which practically ceases in the event of hyperandrogenism).

Content:

A situation often arises when significant changes in hormonal levels are observed. In these cases, hyperandrogenism in women is diagnosed, in which the androgen hormone is produced in too large quantities. It belongs to the category male hormones and performs many necessary functions in the female body. The pathological condition causes unpleasant consequences requiring mandatory treatment.

What is hyperandrogenism

The production of androgens in the female body is carried out with the help of adipocytes, adrenal glands and ovaries. Under the influence of these hormones, women experience puberty and hair appears in the genital area and armpits. They are directly related to reproductive system and muscle growth, regulate the functions of the kidneys and liver. Androgens are of great importance for mature women, participating in the synthesis of estrogen, strengthening bone tissue and maintaining normal libido levels.

However, in some cases, pathological conditions occur, known in medicine as hyperandrogenism. This pathology is considered the most common cause complete absence menstruation – amenorrhea and infertility. The follicles of the female ovaries are surrounded by cellular layers, and excess androgens significantly slow down or completely stop follicular growth. As a result, overgrowth of the follicles occurs, which is called follicular atresia. In addition, male hormones that exceed the norm contribute to the development of fibrosis of the ovarian capsule. Subsequently, multiple cysts form on the ovaries - polycystic disease.

The occurrence and development of hyperandrogenism is influenced by the hypothalamus, which is represented as a regulatory section of the brain. It helps control metabolic processes in the body, under its guidance, the reproductive and endocrine glands function. The hypothalamus mediates the interaction between hormonal and nervous system. For immediate hormonal metabolism the pituitary gland, which is the main endocrine gland located in the brain stem.

Hyperandrogenism is closely associated with disorders of central origin, when the hypothalamus and pituitary gland begin to malfunction. An important role is played by the adrenal glands, which are formed in the form of two small endocrine glands located above the kidneys.

Causes of hyperandrogenism

This pathology arises and develops for various reasons. Among them, the most widespread is adrenogenital syndrome, which promotes an increase in male sex hormones. The adrenal glands produce not only androgens, but also other hormones, such as glucocorticoids. A special enzyme acts on male hormones and converts them into glucocorticoids. If the process of this synthesis is disrupted, the conversion of androgens does not occur, so they accumulate and have negative impact on tissues and organs.

Quite often, hyperandrogenism appears under the influence of an adrenal tumor. The number of cells producing androgens increases, and the amount of male sex hormones increases accordingly. In addition, the ovaries or ovarian tumors, which contain cells that promote the production of androgens, can play a negative role. A serious cause may be pathology of an endocrine organ, such as the pituitary gland or thyroid gland. If the functions of the hypothalamus and pituitary gland are impaired, body weight during illness can increase significantly.

Symptoms of hyperandrogenism

Hyperandrogenism manifests itself in the form of acne, when the excretory ducts are clogged and hair follicles are affected. This situation is typical for women over 20 years of age.

Excessive influence of androgens leads to increased secretion production by the sebaceous glands. As a result, seborrhea occurs, under the influence of which the scalp, neck and face suffer. In some cases, the chest and back are affected.

Symptoms of hyperandrogenism can manifest as alopecia. This mechanism is based on periods of growth and rest, which is rhythm of life hair follicles. They react differently to increased amount androgens. The greatest sensitivity to male hormones manifests itself in the crown area, as well as in the forehead and temples. Blood vessels, located near the follicles are subject to spasms, which disrupts blood circulation and all normal processes. As a result, the follicles die, and androgenic alopecia forms, indicating a high level of production of male hormones.

Hyperandrogenism can manifest itself as hirsutism. In this case, women experience excessive growth hair in areas dependent on the action of androgens. The reason for this condition is the prolonged effect of excess male hormones on the hair follicles. As a result, vellus hair becomes coarse, rod-shaped and pigmented. Under the influence, masculine traits can be formed.

Hyperandrogenism of ovarian origin

This type of pathology is more common in women of reproductive age, in approximately 4-5% of cases. It occurs for many reasons, but the key factor is considered to be a malfunction of the pituitary-hypothalamus system. As a result, excessive production of LH is stimulated, and the ratio between the gonadotropic hormones LH and FSH increases.

If LH is observed in large or excessive quantities, hyperplasia occurs connective tissue protein membrane of the ovaries. In this case, the granulosa and outer layer of the follicles suffer. For this reason, the number of ovarian androgens increases, masculinization becomes noticeable. FSH produced in insufficient quantities leads to untimely maturation of follicles and the onset of anovulation, which requires treatment.

Adrenal hyperandrogenism

One form of pathology is adrenal hyperandrogenism, characterized by a delay in cortisol production. Because of this, the production of ACTH by the pituitary gland and further synthesis of hydroxyprogesterone are stimulated. Ultimately, hyperproduction of androgens occurs.

ACTH accumulates in the blood and cortisol levels increase. Increased amounts of 17-hydroxycorticosteroids or 17-ketosteroids are excreted in the urine. These indicators are of great importance and are used in the diagnosis of AGS. All of these movements are associated with the adrenal cortex, so this type of AGS is called hyperandrogenism of adrenal origin. Most often it manifests itself in a congenital form, but can occur in a postnatal and postnatal form. This pathology has a negative impact on reproductive abilities and may negatively affect your ability to become pregnant.

Diagnostics

First, you need to determine the reason why the number of androgens increases in women. Installed exact time when the characteristic symptoms of this pathology appeared. As a rule, they appear gradually, at the beginning of puberty. In some cases, with the onset of reproductive age, it is possible sudden appearance. Thus, based on the data obtained, the appearance of hyperandrogenism is associated with the presence of tumors in the adrenal glands and ovaries.

Diagnosis of the disease occurs different methods. Blood and urine are examined first. The content of male sex hormones and their breakdown products is determined. The presence of other types of hormones is determined. Additional diagnostics carried out with the help ultrasound examination genitals. Tomography, ultrasound and other types of special studies are used to check the adrenal glands.

Treatment of hyperandrogenism

Treatment measures are carried out in accordance with the main causes of the disease and the expected result. For example, in the case of planning a pregnancy, the therapy will be prescribed differently than in the treatment of ordinary external manifestations of pathology.

Conservative treatment includes weight loss measures, dietary management, exercise and sports, as well as taking medications that reduce the secretion of androgens.

At the same time, existing concomitant diseases are treated, due to which hyperandrogenism appears in women. Among them, you should first of all pay attention to diseases of the liver and thyroid gland, adrenogenital syndrome and polycystic ovary syndrome. Benign and malignant tumors, which secrete androgens, are removed by surgical intervention. In some cases, complex treatment is carried out, combining several different methods.

Hyperandrogenism- this is a pathological condition endocrine system female body, developing as a result of excessive synthesis of male sex hormones by the ovaries or adrenal cortex. Hyperandrogenism syndrome is one of the most common endocrine pathologies, observed exclusively among females at different ages, along with the incidence of thyroid pathology.

When determining the tactics of observation and treatment of patients who exhibit signs of hyperandrogenism, it should be taken into account that this pathology is not identified with an increase in the level of androgenic hormones in the blood serum. Many women may have clinical criteria for hyperandrogen syndrome and no laboratory signs of increased levels of androgens in the circulating blood.

Causes of hyperandrogenism

The pathogenetic mechanisms for the development of hyperandrogenism are either the excessive synthesis of male sex hormones by the adrenal cortex and ovaries, or the increased formation of androgenic hormones from their precursors. In some situations, the development of clinical signs of hyperandrogenism, for example, occurs when the sensitivity of target tissues to even normal amounts of androgenic hormones in the blood increases. At the same time, as a clinical symptom of hyperandrogenism, in almost 90% of cases it is caused by an increase in the level of androgenic hormones in the blood serum.

A rare etiopathogenetic mechanism for the development of hyperandrogenism is a significantly reduced level of globulins responsible for the binding of sex hormones. The action of this globulin is aimed at preventing the penetration of androgenic hormones into the cell, thereby disrupting the interaction of androgenic hormones with specific receptors. The production of androgenic hormones is indirectly influenced by the state of the hormone-synthesizing function of the thyroid gland, therefore various pathological changes in this endocrine organ inevitably provoke hyperandrogenic syndrome.

There are a number of diseases associated with varying degrees intensity of hyperandrogenism. For example, with Stein-Leventhal syndrome or, ovarian hyperandrogenism develops, the manifestations of which most often include dysmenorrhea, increased hair growth, as well as the inability to conceive and bear a fetus. In the postmenopausal period, the cause of the development of the ovarian form of hyperandrogenism can be hyperthecosis, in which patients are concerned about obesity, a tendency to, and when instrumental study Sometimes signs of the uterus and decreased glucose tolerance are detected.

Adrenal hyperandrogenism in the classical form develops when congenital hyperplasia adrenal cortex, which belongs to the category of hereditary genetic diseases. This pathology is characterized by the congenital presence and subsequent progression of the following clinical signs: arterial hypertension, virilization, abnormal development of the external genitalia and retinopathy. Fortunately, this pathology is quite rare, but there is another pathological syndrome, causing hyperandrogenism called Cushing's syndrome. The development of this syndrome, accompanied by the appearance of all clinical signs of hyperandrogenism, most often results from tumor damage to the adrenal glands, but in some situations Cushing's syndrome develops under the exogenous influence of increased doses of glucocorticosteroid drugs, which are used for a wide range of pathological conditions human body.

A separate category of patients with signs of hyperandrogenism consists of patients with tumor lesions of the ovaries and adrenal glands, since in Lately There has been a significant increase in the incidence of androgen-secreting forms of cancer pathologies.

Symptoms of hyperandrogenism

Hyperandrogenism in women of reproductive age is accompanied by a wide range of clinical manifestations, each symptom of which can be attributed to one of three main syndromes: gynecological, dysmetabolic and cosmetic.

At the onset of this pathology, a woman experiences various forms of menstrual irregularity, manifested in its irregularity, up to the development, which directly depends on the level of androgenic hormones in the circulating blood. U large quantities women suffering from hyperandrogenism, there is a tendency to develop an anovulatory menstrual cycle, provoked by insufficient progesterone in the blood and, on the contrary, an increase in estrogen levels. In addition to ovulation disorders, this hormonal imbalance during short period provokes development hyperplastic processes in the endometrium up to the proliferation of neoplastic processes. In this regard, hyperandrogenism is one of the provoking factors of secondary infertility.

In a situation where hyperandrogenism in girls is congenital, anomalies of the external genitalia are formed in the form of clitoral hypertrophy, partial fusion of the labia majora, and urogenital sinus.

The symptom complex of a cosmetic defect includes hirsutism and various forms of skin lesions. Hirsutism or increased hair growth is the most common and pathognomonic clinical criterion of hyperandrogenism and consists of increased hair growth in the projection of the midline of the abdomen, face, lateral surfaces of the neck and chest with simultaneous hair loss on the head. Women suffering from hyperandrogenism are more likely than others to develop common skin rashes according to the type of acne and severe dryness of the skin with areas of excessive peeling.

Signs of dysmetobolic disorders that occur in any form of hyperandrogenism are the appearance of excess weight, atrophy of muscle fibers and the formation of impaired glucose tolerance, which is a provocateur of the development of dysmetabolic and obesity.

A rather specific manifestation of hyperandrogenism is baryphonia, which implies a deepening of the voice that has nothing to do with organic pathology of the vocal cords. In a situation where signs of hyperandrogenism develop in at a young age, noted increased development muscle mass of the trunk with maximum redistribution in upper half chest, shoulder girdle.

Hyperandrogenism during pregnancy

Among all the possible causes of spontaneous abortion in a pregnant woman in the first trimester, hyperandrogenism occupies a leading position. Unfortunately, when detecting signs of hyperandrogenism in a woman during an existing pregnancy, it is extremely difficult to determine whether this pathology is congenital or acquired. In this period, determining the genesis of the disease is not so of great importance, since it is necessary to take all measures to maintain pregnancy as a priority.

The phenotypic signs of hyperandrogenism in a pregnant woman are no different from the manifestations of this pathological condition in any other female, with the only difference being that in some situations hyperandrogenism manifests itself in the form of early termination of pregnancy, which is not always regarded by the woman as a miscarriage. The development of spontaneous miscarriage in the early stages is due to insufficient attachment of the fertilized egg to the wall of the uterus and its rejection even with the slightest traumatic influence. A striking clinical manifestation of this condition is the detection of vaginal bleeding, which, by the way, may not be so intense, nagging pain in the suprapubic region and leveling the signs of early toxicosis.

After the 14th week of pregnancy, physiological conditions are created to prevent abortion, since during this period there is an increase in the activity of female sex hormones secreted by the placenta in large quantities.

Another critical period for the threat of miscarriage in a woman suffering from hyperandrogenism is when there is an active release of dehydroepiandrosterone by the fetal adrenal glands, which inevitably provokes increased androgenization of the pregnant woman. A complication of these pathological changes is the development of signs of isthmic-cervical insufficiency, which can provoke the onset of premature delivery. In the third trimester of pregnancy, hyperandrogenism is a provocateur of early effusion amniotic fluid, as a result of which a woman can give birth ahead of schedule.

To determine hyperandrogenism in a pregnant woman, it is advisable to use only laboratory diagnostic methods, which are fundamentally different from the examination of the rest of the category of patients. In order to determine the concentration of male sex hormones, it is necessary to examine the urine of a pregnant woman to determine the “sum of 17-ketosteroids.”

It should be borne in mind that not all cases of detection of signs of hyperandrogenism in a pregnant woman should be subject to drug correction, even if the diagnosis is confirmed by laboratory methods. Medication methods Therapy is used only if there is a threat to pregnancy. The drug of choice for the treatment of hyperandrogenism during pregnancy is Dexamethasone, the initial daily dose of which is ¼ tablet, the action of which is aimed at inhibiting the function of the pituitary gland, which has an indirect effect on the production of male sex hormones. Application this drug justified by the complete absence of negative impact on fetal development with simultaneous positive effect in relation to leveling the signs of hyperandrogenism.

In , women suffering from hyperandrogenism must be under the supervision of not only a gynecologist, but also an endocrinologist, since this pathological condition tends to progress and provoke serious complications.

Diagnosis of hyperandrogenism

The fundamental link among all possible diagnostic manipulations for hyperandrogenism is laboratory evaluation level of steroid hormones. In addition to determining steroid hormones, it is advisable to monitor the content of hormones involved in the regulation of steroid production.

Due to the fact that hyperandrogenism is a consequence of a number of diseases that differ in the mechanisms of development and clinical manifestations, diagnostic criteria for each of these pathologies will be different.

Thus, with polycystic ovary syndrome, there is a balancing of the levels of luteinizing hormone and testosterone, a decrease in the level of follicle-stimulating hormone, and in some cases, an increase in prolactin levels in the blood. A nonspecific laboratory sign of hyperandrogenism in polycystic ovary syndrome is an increased concentration of glucose in the blood. Ultrasound scanning using the transvaginal access method allows in almost 100% of cases to visualize a cystic change in the structure of the ovarian parenchyma, accompanied by an increase general parameters ovaries.

Cushing's syndrome is accompanied not only by changes in hormonal status, but also by nonspecific laboratory signs such as lymphopenia, lymphopenia and eosinopenia. An imbalance of hormonal status is the detection of excess levels of hormones produced by the adrenal glands in the blood serum. Radiation imaging methods in this situation are used to diagnose the primary tumor process localized in the adrenal glands, but magnetic resonance imaging is the most informative in terms of detecting small tumors. Due to the fact that Cushing's syndrome with concomitant hyperandrogenism can develop as a consequence of pathological changes in the pituitary gland, the complex of screening examinations of patients in this category necessarily includes craniography with radiometry of the sella turcica.

Diagnosis of congenital adrenal hyperplasia should be carried out during prenatal period fetal life by examining amniotic fluid to determine the level of androstenedione and progesterone. A pathognomonic sign of this pathology is an increase in serum 17-hydroxyprogesterone by more than 800 ng%.

If a patient is suspected of having an adrenergic tumor of the ovaries or adrenal glands, special attention should be paid to assessing testosterone and dehydroepiandrosterone levels, the level of which is significantly increased in these pathologies. As additional diagnostic measures, the implementation of which is necessary for the assessment is possible surgical treatment tumor process, radiation imaging methods are used, as well as magnetic resonance imaging.

Treatment of hyperandrogenism

The choice of treatment for hyperandrogenism largely depends on background disease, which was the cause of the development of this pathological condition, as well as the severity of the disease and severity laboratory signs hyperandrogenism. In this regard, patient management and determination of treatment tactics should be primarily individual, taking into account all the characteristics of each specific patient. In many situations, treatment of hyperandrogenism involves a whole range of therapeutic measures, both conservative and surgical.

Polycystic ovary syndrome, which is the most common cause of ovarian hyperandrogenism, in many cases responds well to conservative treatment using a whole range of hormonal drugs. The patient’s signs of hirsutism are the basis for the use of Medroxyprogesterone in a dose of 150 mg parenterally once every three months until the clinical defect is leveled or long-term use of Spironolactone in a daily dose of 200 mg, which also has beneficial influence to normalize the menstrual cycle. To eliminate uterine bleeding and prevent it, treat acne and reduce the manifestations of hirsutism, oral contraceptives are used combined action(Norgestimate at an average daily dose of 250 mg orally). However, it should be borne in mind that all representatives of this group of drugs are not without side effects, so there is a whole range of states that are absolute contraindication to their use (any location, severe damage to the liver parenchyma, tumor process of any location, the presence of endometriotic lesions). To suppress steroidogenesis, it is recommended to use Ketonazole in a daily dose of 200 mg. Surgical treatment for polycystic ovary syndrome, as a rule, is used only if there is a complete lack of effect from the drug correction, as well as in cases of diffuse widespread cystic changes in the ovarian parenchyma. Currently, electrocoagulation of the ovaries using laparoscopic access is considered the most rational and gentle surgical treatment for polycystic ovary syndrome.

In Cushing's syndrome with signs of hyperandrogenism in patients suffering from oncological pathologies of the adrenal glands, the only effective method treatment is surgical. The preparatory stage before surgical treatment involves the use of drugs whose action is aimed at suppressing steroidogenesis (Ketoconazole in a daily dose of 600 mg). The effectiveness of surgical treatment directly depends on the size of the tumor, such as for sizes not exceeding 10 mm positive result achieved in 80% of cases. In the postoperative period it is advisable to use preventive treatment Methothane in daily dosage 10 g to prevent relapse of tumor substrate growth.

Treatment of congenital adrenal hyperplasia should begin at the stage of intrauterine development of the child, since this pathology leads to the development of severe hyperandrogenism. For this purpose, a pregnant woman is prescribed Dexamethasone at a calculated daily dose of 20 mcg/kg until the sex of the unborn child is determined. In a situation where a woman is carrying a boy, treatment should be stopped. Greatest influence The effectiveness of treatment for congenital adrenal hyperplasia is influenced by early diagnosis and timely appointment hormonal treatment.

In a situation where hyperandrogenism in a patient is a symptom of an androgen-secreting ovarian tumor, the only effective treatment option is a combination of surgery, radiation and chemoprophylactic therapy.

Treatment of women suffering from hyperandrogenism in the postmenopausal period consists of prescribing Climen according to the generally accepted regimen, which has a pronounced antiandrogenic effect.

Cosmetological manipulations to eliminate cosmetic defects, which worry most women with hyperandrogenism, should be of secondary importance, and their implementation is recommended only if combined with basic methods of drug treatment.

The pathological state of hormonal balance in the female body, in which there is excessive production of male sex hormones - androgens, is called hyperandrogenism. The disease is associated with disturbances in the functioning of the endocrine system. Hyperandrogenism syndrome is observed in approximately 5-7% of women, about 20% of them cannot become pregnant or bear a child.

Normally, androgens are produced by the genitals in quantities that ensure the growth of pubic and armpit hair, the formation of the clitoris, timely puberty and sexual attraction. Androgens are responsible for normal work liver and kidneys.

Active production of androgens occurs in adolescence, during the formation of secondary sexual characteristics. In adulthood, androgens are necessary to strengthen bone tissue. However, excessive production of these hormones leads to pathological changes, which significantly worsen a woman’s quality of life. The most disastrous results include and. In these cases, treatment is necessary that will help normalize hormonal levels.

Types and causes of the syndrome

The process of androgen maturation occurs in the ovaries and adrenal glands. The normal amount of hormone produced and its correct ratio with estrogens provides the hormonal balance necessary for the full functioning of the body.

Depending on the origin of the pathology, there are several forms:

Hyperandrogenism of ovarian origin – occurs with polycystic ovary syndrome. The reason is a disruption of the hypothalamic-pituitary system. The disorder is hereditary.
Hyperandrogenism of adrenal origin is caused by disruption of the adrenal cortex. The disease is congenital and can also be caused by tumors (Itsenko-Cushing's disease). In this case, the first menstruation begins late, with scanty discharge, and over time it may stop altogether. Other characteristic features– an abundance of acne in the back and chest, underdevelopment of the mammary glands, formation of a male-type figure, enlargement of the clitoris.

A number of patients are diagnosed with hyperandrogenism mixed origin. In this case, the functioning of the ovaries and adrenal glands is simultaneously impaired in the body. This pathology is caused by hypothalamic and neuroendocrine disorders. Disturbances in hormonal balance are aggravated by vegetative-neurotic disorders. In some cases, mild hyperandrogenism is diagnosed, in which androgen levels are normal, but does not reveal the presence of tumors in the internal organs.

The mixed form prevents pregnancy and makes it impossible to successfully bear a child.

Considering the degree of excess of the permissible level of androgens, absolute and relative forms of adrenogenital syndrome are distinguished. In the first case, the concentration of male hormones exceeds acceptable standards. Relative hyperandrogenism is diagnosed with acceptable levels of male hormones. At the same time it is noted increased sensitivity organs and glands of a woman to their effects.

To summarize, the following main causes of this syndrome can be identified:

improper production of a special enzyme that synthesizes androgens, resulting in their excessive accumulation in the body;
presence of adrenal tumors;
diseases and malfunctions of the ovaries, provoking excessive production of androgens;
pathologies of the thyroid gland (hypothyroidism), pituitary tumors;
long-term use of steroids during professional activities by force sports;
obesity in childhood;
genetic predisposition.

If there are disturbances in the functioning of the ovaries, enlargement of the adrenal cortex, hypersensitivity of skin cells to the effects of testosterone, tumors of the reproductive and thyroid glands, pathology may develop in childhood.

Congenital hyperandrogenism sometimes makes it impossible to accurately determine the sex of a born child. A girl may have large labia and a clitoris enlarged to the size of a penis. The appearance of the internal genital organs is normal.

One of the varieties of adrenogenital syndrome is the salt-wasting form. The disease is hereditary and is usually detected in the first months of a child’s life. As a result of unsatisfactory functioning of the adrenal glands, girls experience vomiting, diarrhea, and convulsions.

In older age, hyperandrogenism causes excess hair growth throughout the body, delayed formation of mammary glands and the appearance of the first menstruation.

Clinical manifestations

Symptoms can range from mild (excessive body hair growth) to severe (development of secondary male sexual characteristics).

Clinical manifestations of hyperandrogenism in women in the form of acne and male pattern hair growth

The main manifestations pathological disorders are:

acne – occurs when the skin is too oily, which leads to blockage and inflammation sebaceous glands;
seborrhea hairy skin heads;
hirsutism - the appearance of heavy hair growth in places atypical for women (face, chest, abdomen, buttocks);
thinning and loss of hair on the head, the appearance of bald patches;
increased muscle growth, formation of male-type muscles;
deepening of voice timbre;
, scarcity of discharge, sometimes complete cessation of menstruation;
increased sexual desire.

Occurring disruptions in hormonal balance cause the development of diabetes mellitus, the appearance excess weight, lipid metabolism disorders. Women become very susceptible to various infectious diseases. They often develop depression, chronic fatigue, increased irritability and general weakness.

One of the most severe consequences of hyperandrogenism is virilization or virile syndrome. This is the name given to the pathology of the development of the female body, in which it acquires pronounced male characteristics. Virilization is a rare disorder; it is diagnosed in only one patient out of 100 who experience excessive body hair growth.

A woman develops male figure with increased muscle growth, menstruation stops completely, and the size of the clitoris increases significantly. Often similar signs develop in women who uncontrollably take steroids to increase endurance and physical strength during sports.

Establishing diagnosis

Diagnosis of a pathological condition includes external and gynecological examination patient, analysis of her complaints about general health. Pay attention to the duration of the menstrual cycle, localization excess hair growth, body mass index, appearance genitals.

What tests need to be taken to determine androgen levels?

Doctors (gynecologist, endocrinologist, geneticist) prescribe the following studies:

determination of the level of testosterone, follicular hormone, prolactin, estradiol in the blood and cortisol in the urine;
tests with dexemethasone to determine the cause of the syndrome;
Ultrasound of the ovaries and adrenal glands;
CT scan of the pituitary gland;
studies of glucose, insulin, cholesterol levels.

An ultrasound of the pelvic organs will determine the possible presence. Testing is necessary to determine the type of disease.

Materials for research are taken in the morning, before meals. Since hormonal levels are unstable, for an accurate diagnosis three samples are taken at intervals of at least half an hour. It is advisable to take tests in the second half of the menstrual cycle, closer to the expected start of menstruation.

Principles of therapy

Treatment of hyperandrogenism should be comprehensive and, first of all, aimed at eliminating problems and diseases that act as provoking factors. The list of such diseases includes pathologies of the thyroid gland, polycystic ovary syndrome, and adrenogenital syndrome.

The choice of treatment methods depends on the form of the pathology and the goal pursued by the therapy (combat hirsutism, restore reproductive function, maintain pregnancy when there is a threat of miscarriage).

Main treatment measures include:

drug therapy;
surgical intervention;
use of traditional medicine;
normalization of nutrition and physical activity.

Conservative therapy

It is used to reduce the amount of male hormones produced and to block processes that contribute to their excessive activity. The presence of tumors in the genital organs, causing ovarian hyperandrogenism, is eliminated through surgery.

If a woman is not planning a pregnancy in the near future, but suffers from acne and an excessive amount of body hair, to get rid of these symptoms, they are prescribed with an antiandrogenic effect (for example, Diana 35).

Such drugs not only eliminate unpleasant external signs, but also help normalize the menstrual cycle. For a cosmetic effect, anti-inflammatory ointments are prescribed that reduce sebum production.

If there are contraindications to the use of contraceptives, Spironolactone is used for treatment. It is prescribed for severe premenstrual syndrome and polycystic ovaries. The drug successfully treats acne and excess hair growth.

An analogue drug is Veroshpiron. His main active substance also spironolactone. Taking Veroshpiron is highly undesirable without consulting your doctor about the duration of use and the required dosage.

If hyperandrogenism is caused by the lack of an enzyme that converts androgens into glucocorticoids, agents that normalize this process are indicated. The drug Metipred is very effective. Its release forms are tablets and powders for injection. The drug is contraindicated in the presence of infectious and viral diseases, tuberculosis, heart failure. The duration of the course of treatment and dosage are determined by the doctor.

Drugs used to treat hyperandrogenism

One of the successful methods of conservative treatment is a low-calorie diet. It is necessary to get rid of excess weight, which often complicates the course of the disease and brings additional psychological discomfort to the woman.

The total number of calories consumed daily should not exceed 2000. In this case, with sufficient physical activity, the number of calories consumed will be lower than those expended, which will lead to gradual weight loss.

The diet indicated for hyperandrogenism involves the exclusion of fatty, salty and spicy foods, as well as alcohol, sauces and fatty gravy.

Compliance with the principles proper nutrition reinforced by regular exercise. Running, aerobics, swimming, active games in the fresh air are useful.

The fight against hirsutism is carried out using various cosmetic procedures: waxing, depilation, laser removal of unwanted hair.

Application of traditional medicine

Treatment with folk remedies is quite applicable in combination with drug therapy, but is not a complete replacement for traditional methods.

Popular recipes:

The herbs of sweet clover, sage, meadowsweet and knotweed are mixed in equal parts, poured with 200 ml of water, kept in a water bath for 20 minutes and filtered. Add 1.5 ml of Rhodiola rosea tincture to the resulting decoction. Take a third of a glass of the decoction several times a day before meals.
2 tablespoons of chopped string, 1 spoon of yarrow and motherwort are poured with boiling water, left for about an hour, filtered. Take half a glass on an empty stomach in the morning and before bed.
A few tablespoons of dried nettle leaves are poured into a glass of water, infused in a closed container, and filtered. Take a tablespoon several times a day.
Rose hips and black currants are poured with boiling water and left for about an hour. Then add a little honey. The resulting cocktail is drunk several times a day after meals.

Among the most common folk remedies in the fight against gynecological diseases - hog queen. It is used in conjunction with others medicinal products in the form of a decoction or tincture.

Pour 100 g of boron uterus into 500 ml of vodka and leave for 2 weeks. Take 0.5 teaspoon of tincture three times a day.
Pour 2 tablespoons of boron uterus with a glass of boiling water and leave for about an hour. Drink in small portions throughout the day.
Mix 100 g of green peeled nuts and boron uterus with 800 g of sugar, add the same amount of vodka. Place the bottle with the mixture in a dark place for 14 days. After straining, take a teaspoon half an hour before meals.

Peppermint is used to reduce the amount of androgens produced. On its basis, tinctures and teas are prepared. For greater effectiveness, you can add milk thistle to mint. Regular intake of green tea normalizes female hormonal balance.

How to treat the problem with medicinal herbs and to combine this method with other types of treatment, the attending physician will always advise. Self-medication is unacceptable!

Hyperandrogenism and infertility

Excess androgen production often becomes an obstacle to a desired pregnancy.

How to get pregnant with the help of drug therapy and how realistic is it?

Infertility treatment in this case is aimed at using drugs that stimulate the release of eggs from the ovaries. An example of such a drug would be Clomiphene.

One of the most effective drugs used to stimulate ovulation and normalize the menstrual cycle is Duphaston. After pregnancy occurs, the drug is continued to prevent miscarriage and normalize the development of pregnancy.

If stimulation is ineffective, doctors advise resorting to surgical treatment. Modern medicine widely uses the method. During this procedure, the ovaries are excised to help the mature egg “release.” The chance of getting pregnant after laparoscopy is higher, the less time passes from the day of surgery. Maximum fertility is observed in the first three months.

But even after successful conception the presence of hyperandrogenism can prevent successful pregnancy. Excess male hormones often lead to the fact that the fertilized egg cannot stay in the uterus. The likelihood of miscarriage remains high.

Dangerous weeks of pregnancy with hyperandrogenism are the period before the 12th week and after the 19th. In the first case, hormones are produced by the placenta, and after the 19th week they can be produced by the fetus itself.

To maintain pregnancy, the patient is prescribed Dexamethasone (metipred). It helps reduce androgen levels. The dosage of the drug is selected exclusively by the doctor!

Many expectant mothers are very afraid of the side effects of the drug and fear that it could harm the unborn baby. Many years of experience in using this drug proves its safety, both for the development of the unborn child and for the course of the birth itself.

In most cases, to avoid the risk of miscarriage, doctors advise you to first undergo full course treatment, and only then plan a pregnancy. If a woman fails to conceive a child, it is possible to carry out.

Prevention

There are no specific measures to prevent hyperandrogenism, since this syndrome develops at the hormonal level.

To general preventive measures include:

balanced diet, including foods rich in fiber in the menu, weight control;
quitting smoking and alcohol abuse;
regular visits to the gynecologist;
taking medications and contraception only after a doctor’s recommendation;
timely treatment of pathologies of the thyroid gland, liver and adrenal gland diseases.

Hyperandrogenism is not only problems with skin, hair and menstrual cycle. This is a general disease of the body that does not allow a woman to lead a quality lifestyle and often deprives her of the joys of motherhood. Modern methods of diagnosis and treatment make it possible to identify pathology in time and successfully eliminate its manifestations.

Hyperandrogenism – general designation a number of endocrine pathologies of different etiologies, characterized by excessive production of male hormones - androgens in a woman’s body or increased susceptibility to steroids on the part of target tissues. Most often, hyperandrogenism in women is first diagnosed at reproductive age - from 25 to 45 years; less often – in girls in adolescence.

Source: klinika-bioss.ru

To prevent hyperandrogenic conditions, preventive examinations by a gynecologist and screening tests to monitor androgen status are recommended for women and adolescent girls.

Causes

Hyperandrogenism is a manifestation of a wide range of syndromes. Experts name the three most probable reasons hyperandrogenism:

increased levels of androgens in blood serum;
conversion of androgens into metabolic active forms;
active utilization of androgens in target tissues due to abnormal sensitivity of androgen receptors.

Excessive synthesis of male sex hormones is usually associated with ovarian dysfunction. The most common is polycystic ovary syndrome (PCOS) - the formation of multiple small cysts against the background of a complex of endocrine disorders, including pathologies of the thyroid and pancreas, pituitary gland, hypothalamus and adrenal glands. The incidence of PCOS among women of fertile age reaches 5–10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

adrenogenital syndrome;
congenital adrenal hyperplasia;
galactorrhea-amenorrhea syndrome;
stromal thecomatosis and hyperthecosis;
virilizing tumors of the ovaries and adrenal glands that produce male hormones.

Hyperandrogenism due to the transformation of sex steroids into metabolically active forms is often caused by various disorders of lipid-carbohydrate metabolism, accompanied by insulin resistance and obesity. Most often, the transformation of testosterone produced by the ovaries into dihydrotestosterone (DHT) is observed - steroid hormone, stimulating the production of sebum and the growth of hair shafts on the body, and in rare cases, hair loss on the head.

Compensatory hyperproduction of insulin stimulates the production of ovarian cells that produce androgens. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptor cells in the tissues of the ovaries, skin, hair follicles, sebaceous and sweat glands symptoms of hyperandrogenism may occur with normal level sex steroids in the blood.

The severity of symptoms depends on the cause and form of endocrinopathy, concomitant diseases and individual characteristics.

The likelihood of manifestation of pathological conditions associated with the hyperandrogenism symptom complex depends on a number of factors:

hereditary and constitutional predisposition;
chronic inflammatory diseases ovaries and appendages;
miscarriages and abortions, especially in early youth;
metabolic disorders;
excess body weight;
bad habits - smoking, alcohol and drug abuse;
distress;
long-term use of medications containing steroid hormones.

Idiopathic hyperandrogenism is congenital or occurs in childhood or puberty for no apparent reason.

Kinds

In gynecological practice, there are several types of hyperandrogenic conditions, which differ from each other in etiology, course and symptoms. Endocrine pathology can be either congenital or acquired. Primary hyperandrogenism, not associated with other diseases and functional disorders, is caused by disorders of pituitary regulation; secondary is a consequence of concomitant pathologies.

Based on the specifics of manifestation, absolute and relative types of hyperandrogenism are distinguished. The absolute form is characterized by an increase in the level of male hormones in a woman’s blood serum and, depending on the source of androgen hypersecretion, is divided into three categories:

ovarian, or ovarian;
adrenal, or adrenal gland;
mixed - signs of the ovarian and adrenal forms are simultaneously present.

Relative hyperandrogenism occurs against the background of normal levels of male hormones with excessive sensitivity of target tissues to sex steroids or increased transformation of the latter into metabolically active forms. A separate category includes iatrogenic hyperandrogenic conditions that develop as a result of prolonged use of hormonal drugs.

The rapid development of signs of virilization in an adult woman gives reason to suspect an androgen-producing tumor of the ovary or adrenal gland.

Symptoms of hyperandrogenism

The clinical picture of hyperandrogenic conditions is characterized by a wide variety of manifestations that fit into a standard set of symptoms:

menstrual dysfunction;
metabolic disorders;
androgenic dermopathy;
infertility and miscarriage.

The severity of symptoms depends on the cause and form of endocrinopathy, concomitant diseases and individual characteristics. For example, dysmenorrhea manifests itself especially clearly with hyperandrogenism of ovarian origin, which is accompanied by abnormalities in the development of follicles, hyperplasia and uneven exfoliation of the endometrium, and cystic changes in the ovaries. Patients complain of scanty and painful menstruation, irregular or anovulatory cycles, uterine bleeding and premenstrual syndrome. In galactorrhea-amenorrhea syndrome, there is a deficiency of progesterone.

Severe metabolic disorders - dyslipoproteinemia, insulin resistance and hypothyroidism are characteristic of the primary pituitary and adrenal forms of hyperandrogenism. In approximately 40% of cases, patients are diagnosed with abdominal obesity of the male type or with uniform distribution adipose tissue. With adrenogenital syndrome, an intermediate structure of the genitals is observed, and in the most severe cases, pseudohermaphroditism. Secondary sexual characteristics are weakly expressed: in adult women there is underdevelopment of the breasts, a decrease in the timbre of the voice, an increase in muscle mass and body hair; For girls, late menarche is typical. The rapid development of signs of virilization in an adult woman gives reason to suspect an androgen-producing tumor of the ovary or adrenal gland.

Androgenic dermopathy is usually associated with increased dihydrotestosterone activity. The effect of a hormone that stimulates secretory activity skin glands, changes physicochemical characteristics sebum, causing blockage of the excretory ducts and inflammation of the sebaceous glands. As a result, 70–85% of patients with hyperandrogenism have signs of acne - acne, enlarged skin pores and comedones.

Hyperandrogenic conditions are one of the most common causes of female infertility and miscarriage.

Less common are other manifestations of androgenic dermatopathy - seborrhea and hirsutism. Unlike hypertrichosis, in which there is excess hair growth throughout the body, hirsutism is characterized by the transformation vellus hair into hard terminal hair in androgen-sensitive areas - above upper lip, on the neck and chin, on the back and chest around the nipple, on the forearms, legs and inside hips. In postmenopausal women, bitemporal and parietal alopecia are occasionally observed - hair loss on the temples and in the crown area, respectively.

Source: woman-mag.ru

Features of hyperandrogenism in children

During the pre-pubertal period, girls may develop congenital forms hyperandrogenism caused by genetic abnormalities or exposure of the fetus to androgens during pregnancy. Pituitary hyperandrogenism and congenital adrenal hyperplasia are recognized by the pronounced virilization of the girl and abnormalities in the structure of the genitals. With adrenogenital syndrome, signs of false hermaphroditism may be present: hypertrophy of the clitoris, fusion of the labia majora and vaginal opening, displacement of the urethra to the clitoris and urethrogenital sinus. At the same time the following are noted:

early overgrowth of fontanelles and epiphyseal fissures in infancy;
premature body hair growth;
rapid somatic growth;
delayed puberty;
late menarche or absence of menstruation.

Congenital adrenal hyperplasia is accompanied by disturbances in water-salt balance, skin hyperpigmentation, hypotension and autonomic disorders. Starting from the second week of life, with congenital adrenal hyperplasia and severe adrenogenital syndrome the development of adrenal crisis is possible - acute adrenal insufficiency associated with a threat to life. Parents should be alert sharp drop blood pressure to a critical level, vomiting, diarrhea and tachycardia in a child. In adolescence, an adrenal crisis can be triggered by nervous shocks.

Moderate hyperandrogenism in adolescence, associated with a sharp growth spurt, should be differentiated from congenital polycystic ovary syndrome. The debut of PCOS often occurs at the stage of formation of menstrual function.

Congenital hyperandrogenism of adrenal origin in children and adolescent girls can suddenly be complicated by an adrenal crisis.

Diagnostics

You can suspect hyperandrogenism in a woman by characteristic changes appearance and based on medical history. To confirm the diagnosis, determine the form and identify the cause of the hyperandrogenic condition, a blood test is performed for androgens - total, free and biologically available testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate (DHEA sulfate), as well as sex hormone binding globulin (SHBG).

In hyperandrogenic conditions of adrenal, pituitary and transport etiology, the woman is referred to an MRI or CT scan of the pituitary gland and adrenal glands. If indicated, blood tests are performed for 17-hydroxyprogesterone and urine tests for cortisol and 17-ketosteroids. Laboratory tests are used to diagnose metabolic pathologies:

tests with dexamethasone and human chorionic gonadotropin;
determination of cholesterol and lipoprotein levels;
blood tests for sugar and glycogen, glucose tolerance test;
tests with adrenocorticotropic hormone.

To improve the visualization of glandular tissue, if a neoplasm is suspected, MRI or CT with the use of contrast agents is indicated.

Treatment of hyperandrogenism

Correction of hyperandrogenism gives lasting results only as part of the treatment of underlying diseases, such as PCOS or Itsenko-Cushing syndrome, and associated pathologies - hypothyroidism, insulin resistance, hyperprolactinemia, etc.

Hyperandrogenic conditions of ovarian origin are corrected with the help of estrogen-progestogen oral contraceptives, suppressing the secretion of ovarian hormones and blocking androgen receptors. For severe androgenic dermopathy, peripheral blockade of receptors in the skin, sebaceous glands and hair follicles is performed.

In the case of adrenal hyperandrogenism, corticosteroids are used; with the development of metabolic syndrome, insulin synthesizers are additionally prescribed in combination with low calorie diet and dosed physical activity. Androgen-secreting neoplasms, as a rule, are benign in nature and do not recur after surgical removal.

For women planning pregnancy, treatment of hyperandrogenism is prerequisite restoration of reproductive function.

Prevention

To prevent hyperandrogenic conditions, preventive examinations by a gynecologist and screening tests to monitor androgen status are recommended for women and adolescent girls. Early detection and treatment gynecological diseases, timely correction of hormonal levels and competent selection of contraceptives successfully prevent hyperandrogenism and help maintain reproductive function.

If you are prone to hyperandrogenism and congenital adrenopathy, it is important to adhere to healthy image life and a gentle regime of work and rest, give up bad habits, limit the influence of stress, lead an orderly sex life, avoid abortions and emergency contraception; Uncontrolled use of hormonal drugs and anabolic drugs. Body weight control is of no small importance; moderate is preferred physical activity without heavy physical activity.

Most often, hyperandrogenism in women is first diagnosed at reproductive age - from 25 to 45 years; less often – in girls in adolescence.

Consequences and complications

Hyperandrogenic conditions are one of the most common causes of female infertility and miscarriage. Long course hyperandrogenism increases the risk of developing metabolic syndrome and type II diabetes mellitus, atherosclerosis, arterial hypertension and coronary heart disease. According to some data, high androgen activity correlates with the incidence of certain forms of breast cancer and cervical cancer in women infected with oncogenic papillomaviruses. In addition, aesthetic discomfort with androgenic dermopathy has a strong psychotraumatic effect on patients.

Congenital hyperandrogenism of adrenal origin in children and adolescent girls can suddenly be complicated by an adrenal crisis. Due to the possibility of death, at the first signs of acute adrenal insufficiency, the child should be immediately taken to the hospital.

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