Syndrome of hyperandrogenism. Hyperandrogenism syndrome: modern approaches to diagnostics and new technologies of therapy

Hyperandrogenism in women is a condition in which an increased level of androgens is determined in the blood, and clinical data of an excess of male sex hormones are also recorded. Found in different age groups. The main causes of hyperandrogenism are adrenogenital syndrome (AGS) and polycystic ovaries (PCOS). Treatment of hyperandrogenism is aimed at correcting the hormonal background and preventing the consequences of androgen excess.

Normally, the hormonal status of a woman allows a certain level of androgens in the blood. From them, under the action of aromatase, part of the estrogens is formed. An excess amount leads to a violation reproductive function, increased risk oncological diseases. The ICD-10 does not classify this syndrome, as it is not a disease.

What causes hyperandrogenism in women

Hyperandrogenism is characterized by an increased concentration in the female body of androgens, which are male sex hormones, among which testosterone is best known. In the fair sex, the adrenal cortex, ovaries, subcutaneous adipose tissue and indirectly the thyroid gland. The whole process is "managed" by luteinizing hormone (LH), as well as adrenocorticotropic hormone (ACTH) of the pituitary gland.

In normal concentration, androgens in the female body exhibit the following properties:

responsible for growth- participate in the growth spurt mechanism and contribute to the development of tubular bones during puberty;
are metabolites- they form estrogens and corticosteroids;
form sexual characteristics- at the level with estrogens, they are responsible for the natural hair growth in women.

The excess content of androgens leads to hyperandrogenism, which manifests itself in endocrinological, cyclic disorders, changes in appearance.

The following can be distinguished primary causes hyperandrogenism.

AGS. Adrenogenital syndrome is characterized by insufficient synthesis or lack of production by the ovaries of the enzyme C21-hydroxylase (converts testosterone to glucocorticoids), which leads to an excess of androgens in the female body.
Polycystic. PCOS can be the cause of androgen excess or a consequence.
Tumors. They can be localized in the ovaries, adrenal glands, in the pituitary and hypothalamus, while they produce an excessive amount of androgens.
Other pathologies. Hyperandrogenism can cause malfunction thyroid gland, liver (where hormones are metabolized), taking hormonal drugs.

These disorders lead to a change in the metabolism of male sex hormones, and there is:

their excessive education;
conversion to active metabolic forms;
increased sensitivity of receptors to them and their rapid death.

Additional factors that may affect the development of hyperandrogenism are:

taking steroids;
elevated prolactin levels;
overweight in the first years of life;
sensitivity (sensitivity) of the skin to testosterone.

Varieties of pathology

Depending on the cause, level and mechanism of development of pathology, the following types hyperandrogenism.

Ovarian. It is characterized by disorders of genetic or acquired origin. Ovarian hyperandrogenism is characterized by rapid development and sudden appearance symptoms. In the ovaries, androgens are converted to estrogens by the enzyme aromatase. In case of violation of its work, there is a deficiency of female sex hormones and an excess of male ones. In addition, ovarian hyperandrogenism can be provoked by hormonally active tumors of this localization.
Adrenal. Such hyperandrogenism is caused by tumors of the adrenal glands (most often androsteromas) and adrenogenital syndrome. The latter pathology is caused by genetic abnormalities of the gene that is responsible for the formation of the C21-hydroxylase enzyme. The lack of this substance for a long time can be compensated for by the work of other hormone-producing organs, so the condition has a latent course. With psycho-emotional overstrain, pregnancy and other stress factors, the enzyme deficiency is not covered, so the AGS clinic becomes more obvious. Adrenal hyperandrogenism is characterized by ovarian dysfunction and menstrual irregularities, lack of ovulation, amenorrhea, corpus luteum insufficiency during egg maturation.
Mixed. A severe form of hyperandrogenism combines ovarian and adrenal dysfunction. The trigger mechanism for the development of mixed hyperandrogenism is neuroendocrine disorders, pathological processes in the area of the hypothalamus. Manifested by violations of fat metabolism, often infertility or miscarriage.
Central and peripheral. Associated with dysfunction of the pituitary and hypothalamus nervous system. There is a deficiency of follicle-stimulating hormone, which disrupts the maturation of the follicles. As a result, the level of androgens rises.
Transport. This form of hyperandrogenism is based on a deficiency of globulin, which is responsible for the binding of sex steroids in the blood, and also blocks the excessive activity of testosterone.

According to the focus of the onset of pathology, the following types of hyperandrogenism are distinguished:

primary - originates in the ovaries and adrenal glands;
secondary - the center of origin in the pituitary gland.

According to the way the pathology develops, the following are distinguished:

hereditary;
acquired.

According to the degree of concentration male hormones hyperandrogenism is:

relative - the level of androgens is normal, but the sensitivity of target organs to them is increased, and male sex hormones tend to turn into active forms;
absolute - the permissible norm of the content of androgens is exceeded.

How does it manifest

Hyperandrogenism manifests itself bright signs, often they are easy to notice even for the layman. Symptoms excessive concentration male hormones depend on the age, type and degree of development of the pathology.

Before puberty

Prior to puberty, hyperandrogenism is due to genetic disorders or hormonal imbalances during prenatal development.
It is clinically manifested by defective anatomy of the external genitalia and pronounced male secondary sexual characteristics.

Adrenal hyperandrogenism in newborn girls is manifested by false hermaphroditism - the vulva is fused, the clitoris is excessively enlarged, the fontanel is overgrown already in the first month. Subsequently, the girls observed:

long upper and lower limbs;
high growth;
excessive amount of hair on the body;
late onset of menstruation (or absent at all);
secondary female sexual characteristics are weakly expressed.

Diagnosis is difficult to carry out with this pathology and ovotestis - the presence of male and female germ cells, which happens with true hermaphroditism.

At puberty

During puberty, girls with hyperandrogenism may experience:

acne on face and body- blocked ducts sebaceous glands and hair follicles
seborrhea - excessive secretion production by the sebaceous glands;
hirsutism - overgrowth hair on the body, including in "male" places (on the arms, back, inside thighs, chin);
NMC - unstable menstrual cycle, amenorrhea.

At reproductive age

If the pathology manifested itself in the reproductive age, all of the above signs can be joined by:

baryphony - coarsening of the voice;
alopecia - baldness, hair loss on the head;
masculinization - increase muscle mass, changing the figure according to the male type, redistribution subcutaneous tissue fat from the hips to the abdomen and upper torso;
increased libido- excessive sexual desire;
breast reduction- mammary glands are small, lactation persists after childbirth;
metabolic disease- expressed in insulin resistance and development diabetes the second type, hyperlipoproteinemia, obesity;
gynecological problems- disruptions in the menstrual cycle, lack of ovulation, infertility, endometrial hyperplasia;
psychoemotional disorders- a tendency to depression, a feeling of loss of strength, anxiety, sleep disturbance;
cardiovascular disorders- Tendency to hypertension, episodes of tachycardia.

All these symptoms are combined into one concept - the viril syndrome, which implies the development of male characteristics and the loss of female characteristics by the body.

In menopause

In women with the onset of menopause, a syndrome of hyperandrogenism occurs due to a decrease in estrogen levels. By this time, many note the appearance of "male hair", especially in the chin and upper lip. This is considered normal, but hormone-producing ovarian tumors must be ruled out.

Diagnostics

Confirmation of pathology requires a comprehensive examination.

Collection of anamnesis. Information about the menstrual cycle, the physique of a woman, the degree of hair coverage of her face and body, the timbre of her voice are taken into account - those signs that indicate an excess of androgens.
Blood tests . For sugar content and for determining the level of testosterone, cortisol, estradiol, 17-hydroxyprogesterone, SHBG (globulin that binds sex hormones), DHEA (dehydroepiandrosterone). Tests for hormones are carried out on the fifth to seventh day of the cycle.
ultrasound. It is necessary to carry out ultrasound procedure thyroid gland, adrenal glands and pelvic organs.
CT, MRI. If you suspect a brain tumor in the pituitary gland or hypothalamus.

If necessary, the range of examinations can be expanded for more detailed diagnostics.

Consequences for the body

Estrogens are responsible not only for the "feminine appearance" and the realization of reproductive potential, but also protect the body from many pathological conditions. An imbalance between estrogens and androgens can lead to the following consequences:

problems with pregnancy- infertility, miscarriage in the early and late periods;
increased risk of developing cancer- endometrium, breast, cervix;
gynecological diseases- more often there are dysfunctions, ovarian cysts, endometrial hyperplasia and polyps, cervical dysplasia, mastopathy;
somatic diseases- a tendency to hypertension and obesity, strokes, heart attacks are more common.

Treatment

Treatment of hyperandrogenism in women is aimed at correcting the hormonal imbalance and eliminating the root cause. Clinical guidelines depends on the age of the woman, the realization of her reproductive potential, the severity of symptoms and other disorders in the body.

Standard Approach. Most often, treatment regimens for this pathology are based on the use of combined hormonal drugs that have an antiandrogenic effect. In some cases, gestagens are enough, for example, Utrozhestan. This therapy is used to correct adrenal and ovarian hyperandrogenism. This tactic does not eliminate the cause of the disease, but helps to fight the symptoms and reduces the risk of complications of hyperandrogenism in the future. It is necessary to take hormones constantly.
Adrenogenital syndrome. It is stopped with the help of corticosteroids, which are also used in preparing a woman for pregnancy. Among the drugs, the most famous is Dexamethasone. "Veroshpiron" can be used to correct the water-salt balance in AGS.
Androgen derived tumors. For the most part they are benign neoplasms but still need to be removed surgically.

With infertility, it is often necessary to resort to ovulation stimulation, IVF, and laparoscopy if polycystic ovaries are diagnosed. Established hyperandrogenism and pregnancy require careful medical supervision due to increased risk pregnancy complications. Reviews of women and doctors confirm this.

The syndrome of hyperandrogenism in women is frequent violation that affects the endocrine system. The disease is accompanied by an increase in the amount of male sex hormones. This negatively affects both the body as a whole and the functioning of the reproductive system. This condition occurs in 5% of women, which is a fairly high rate. The opposite situation is called hypoandrogenism - this is when men have a lack of male sex hormones.

Hyperandrogenic syndrome is a condition that is accompanied by increased production androgens (male sex hormones). Sometimes their normal concentration is observed, which can still have a negative effect on the body. An excess of androgens in the female part of the population is manifested by the appearance of male features. Also, the patient has problems with reproductive function. This syndrome also occurs in men. In them, it manifests itself (an increase in the mammary glands as in women). Also, such men often suffer from impotence and other problems.

Androgens are a group produced by the human body. They are produced by the testicles in men or the ovaries in women. Also, these hormones are produced by the adrenal cortex. Their list includes:

and others.

Androgen synthesis is controlled by substances produced by the pituitary gland. These include adenocorticotropic hormone. The formation of androgens begins with the conversion of cholesterol to pregnenolone. This process is observed in all tissues that are steroid-producing. Subsequently, the synthesis continues in completely different organs. Most often they have nothing to do with steroidogenesis.

At the output, different hormones are formed depending on the organ that is included in the process. The ovaries produce testosterone, estrone,. The adrenal glands produce,. Also this body produces testosterone. In the process of androgen production, not only organs, but also peripheral tissues, for example, subcutaneous adipose tissue, take part.

Symptoms of hyperandrogenism in women

Signs of hyperandrogenism in women are:

. It is characterized by increased male pattern hair growth. In this case, there is an uncharacteristic hairline for women. It can be localized on the abdomen, back, face, chest. In the presence of increased hairiness, the diagnosis of hyperandrogenism should be distinguished from. The latter condition has the same signs, but does not appear due to increased androgens. Increased body hair can develop due to the characteristics of the woman's body, which is the norm. A striking example are representatives from the Central Asian countries;

acne. It is characterized by the formation of acne on the skin (most often on the face). It is accompanied by damage to the hair follicles and sebaceous glands, blockage of the excretory ducts. This problem often worries teenagers, which does not indicate the presence of this syndrome. After 20 years, more than half of the women who have acne are diagnosed with an excess of male sex hormones;
seborrhea. It is characterized by increased secretion of the sebaceous glands. This process is observed on the head, face, neck and other parts of the body. Often seborrhea causes the development of acne or other skin problems among women;
alopecia. hair follicles very sensitive to increased levels of androgens in the blood. Most of all, this phenomenon is observed in the frontal, temporal and parietal regions. Under the influence of male hormones in these areas, the hair changes, becomes much thinner, and eventually falls out completely. As a result, bald patches are formed. Androgenetic alopecia often observed in women who have significantly increased levels of male hormones;

virilization. It is characterized by the appearance of pronounced masculine features in women. This symptom is present in patients with serious pathologies in which androgens are produced in large quantities;
violation of the menstrual cycle. Women are diagnosed differently depending on the nature of the disorder. Often there is opso-oligomenorrhea (the presence of too long or a short interval between periods), amenorrhea ( complete absence menstruation throughout long period);
. May be observed in the presence of pathologies of the adrenal glands or ovaries;
amyotrophy;

decreased immunity as a result;
impaired glucose tolerance;
the presence of sexual organs intermediate type. Such a woman may experience fusion of the labia, clitoral hypertrophy, and other defects. These problems are congenital in nature and appear due to hyperplasia of the adrenal cortex. Such a person can be called an androgyne, which means the combination of a man and a woman in one body;
chronic depression, drowsiness, loss of strength and other signs of hyperandrogenism.

Reasons for the development of the problem

The development of hyperandrogenism syndrome is observed due to such reasons:

hereditary factors. Androgenism in women can be passed from mother to daughter. If the family is found this problem, exists Great chance that it will be inherited;
disruption of the normal functioning of the brain, in particular, or. These departments are involved in the process of formation of hormones of the sexual sphere;

dysfunction of the adrenal cortex. Is congenital pathology, which is characterized by an increase in the production of some hormones and inhibition of others. In 95% of cases, a decrease in the concentration of aldosterone is observed, which leads to improper formation external genital organs of a woman;
the formation of tumors of the ovaries or adrenal glands, which disrupt the normal process of hormone production. They are also called androgen-secreting. With localization on the ovaries, testosterone production increases, on the adrenal glands -;
polycystic ovary syndrome. This is a disease that is characterized by the absence of tumors, but affecting the increase in the production of male hormones in women. Multiple cysts form in the ovaries, which causes. The elevated levels of androgens that are observed in PCOS lead to infertility, obesity, and increased hairiness. During the diagnosis of a sick woman, a chronic absence of ovulation is detected;

adrenogenital syndrome. It is characterized by excessive formation of male sex hormones by the adrenal glands;
. Accompanied by an increase in hormones produced by the adrenal cortex - glucocorticoids. In a sick woman, it is observed where fat is mainly deposited on the face, neck, torso. Other symptoms of the disease are menstrual disorders, infertility, muscle atrophy (mainly on the limbs), osteoporosis, lack of glucose tolerance, osteoporosis, chronic depression. In men, there is an increase in the mammary glands, impotence;
prolactinoma. A tumor located in the pituitary gland. This education affects the production, which is responsible for breast growth, milk formation;

ovarian hyperthecosis and stromal hyperplasia. There is an unnatural growth of their tissues. Most often found in adulthood after 60 years. When examining patients, an increase in the level of estradiol and estrone is determined. The disorder is accompanied by obesity, development arterial hypertension, impaired glucose tolerance, uterine cancer;
high activity of 5-alpha-reductase, which is involved in the production of steroid hormones;
prolonged and uncontrolled intake different type(including oral contraceptives);
violation of the thyroid gland;
chronic liver disease.

Increased androgen production in pregnant women

Androgen excess in pregnant women is dangerous state. In 20-40% of all cases, pregnancy ends in spontaneous abortion on early term. This happens due to a non-developing fetus or anembryony (the absence of an embryo in the fertilizing egg).

Such a problem may be chronic. Each subsequent pregnancy ends in a miscarriage, which leads to such a condition as habitual miscarriage. Secondary infertility develops, and hormonal disorders become more pronounced.

The most critical moments that a woman experiences are the periods when the fetus begins to additionally produce male sex hormones. It happens naturally and observed:

from 12 to 13 weeks of pregnancy;
from 23 to 24;
from 27 to 28.

If it was detected before pregnancy high level androgens in women, treatment occurs at all stages - both before and during gestation. The doctor determines the risk for the woman and the child and prescribes the appropriate medications to normalize the hormonal background.

Diagnosis of the disease

The symptoms and treatment of this problem depend on the cause of the problem. To determine them, an analysis of the patient's condition is carried out. The attending physician takes into account when the characteristic symptoms of hyperandrogenism appeared - in childhood, adolescence or adulthood. Such an analysis will determine the direction of further diagnostics. It should be aimed at increased research certain bodies- ovaries, adrenal glands, etc.

Diagnosis of hyperandrogenism includes:

blood and urine analysis. A study is being conducted to determine the level of androgens and their metabolic products;
Ultrasound of the pelvis. Both conventional and transvaginal are often prescribed;
Ultrasound of the adrenal glands;
tomography.

Treatment

If a high level of androgens has been detected in women, the treatment of this condition occurs with the use of different methods. It all depends on the reason, which should be in without fail defined. Mainly appointed:

taking glucocorticosteroids;
taking antiandrogens. They suppress the production of male sex hormones;
taking estrogen-progestogen drugs. They contain female sex hormones;
use of gonadotropin-releasing hormone agonists. Drugs of this type act on the pituitary gland, which allows you to normalize the hormonal background;
surgical treatment in the detection of tumors;
normalization of weight, adherence to the principles of healthy eating, physical activity.

Prevention

The increased growth of androgens in women is treated in compliance with certain rules that allow you to prevent further development diseases. These include:

balanced diet. It is important to consume healthy food, refuse fatty, salty, smoked, fried, limit the use of sweets;
weight normalization. Excess weight directly affects the increase in the production of male sex hormones;
moderate physical activity. You can join the pool or the gym. Physical activity should be daily, but excessive load should be avoided;
stress prevention. Increased psycho-emotional stress also negatively affects the hormonal background of a woman;
rejection bad habits- smoking, alcohol abuse;
regular visits to the gynecologist;
it is necessary to treat diseases of the thyroid gland, adrenal glands, liver and other organs in a timely manner.

Complications

If the treatment of hyperandrogenism in women was absent or did not give positive result develop the following complications:

diabetes;
habitual miscarriage;
infertility;

Also, sick women complain about cosmetic defects- fatty and problematic skin, increased hair growth and others.

Bibliography

Emergency care for extragenital pathology in pregnant women. 2008, 2nd edition, revised and supplemented, Moscow, Triada-X.
Savicheva A.M., Bashmakova M.A. Urogenital chlamydia in women and its consequences. Ed. E.K. Ailamazyan - N. Novgorod.: Publishing house of NGMA, 1998. -182 p.
Zaporozhan V.M., Tsegelsky M.R. Obstetrics and gynecology. - K.: Health, 1996.-240 p.
New honey. technology (Methodological recommendations) "Management of preterm pregnancy complicated by premature rupture of membranes"; Makarov O.V., Kozlov P.V. (Edited by Volodin N.N.) - RASPM; Moscow; TsKMS GOU VPO RSMU-2006.
Diseases of the cervix, vagina and vulva / Ed. V.N. Prilep-

Graduated from the Kirov State medical academy in 2006. In 2007 she worked at the Tikhvin Central district hospital on the base therapeutic department. From 2007 to 2008, he worked at a hospital for a mining company in the Republic of Guinea (West Africa). From 2009 to the present, he has been working in the field of information marketing. medical services. We work with many popular portals, such as Sterilno.net, Med.ru, website

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

Normally, androgens are produced by the genitals in an amount that ensures the growth of hair on the pubis and in the armpits, the formation of the clitoris, timely puberty and sexual attraction. Androgens are responsible for the normal functioning of the liver and kidneys.

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

Varieties and causes of the syndrome

The process of maturation of androgens 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, several of its forms are distinguished:

Hyperandrogenism of ovarian origin - occurs with polycystic ovary syndrome. The reason is a malfunction of the hypothalamus-pituitary gland system. The disorder is hereditary.
Hyperandrogenism of adrenal origin is caused by a malfunction of the adrenal cortex. The disease is congenital in nature, and can also be caused by tumors (Itsenko-Cushing's disease). In this case, the first menstruation begins late, with meager secretions and, over time, may cease altogether. Other characteristics- an abundance of acne in the back and chest, underdevelopment of the mammary glands, the formation of a figure according to the male type, an increase in the clitoris.

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

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

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

Summing up, the following main causes of this syndrome can be distinguished:

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

With violations of the ovaries, an increase in the adrenal cortex, hypersensitivity of skin cells to the effects of testosterone, tumors of the genital and thyroid glands possible development of pathology in childhood.

Congenital hyperandrogenism sometimes does not allow to accurately determine the sex of the born child. A girl may have large labia, 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-losing form. The disease is hereditary and usually detected in the first months of a child's life. As a result of the unsatisfactory work of the adrenal glands, girls develop vomiting, diarrhea, and convulsions.

At an older age, hyperandrogenism causes excessive hair growth throughout the body, a delay in the formation of the mammary glands and the appearance of the first menstruation.

Clinical manifestations

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

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

The main manifestations of pathological disorders are:

acne - occurs with increased oiliness of the skin, which leads to blockage and inflammation of the sebaceous glands;
seborrhea hairy skin heads;
hirsutism - the appearance of strong hair growth in places atypical for women (face, chest, abdomen, buttocks);
thinning and hair loss on the head, the appearance of bald patches;
increased muscle growth, the formation of muscles according to the male type;
coarsening of the timbre of the voice;
, scarcity of discharge, sometimes complete cessation of menstruation;
increased sex drive.

Occurring failures in the 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 hyperandrogenism is virilization or virilization syndrome. This is what developmental pathology is called. female body, at which it acquires pronounced male signs. Virilization is a rare abnormality, it is diagnosed in only one patient out of 100 who have overgrowth body hair.

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

Establishing diagnosis

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

What tests should be taken to determine the level of androgens?

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 dexamethasone 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.

Ultrasound of the pelvic organs will determine the possible presence. Testing is necessary to establish the type of disease.

Materials for research are taken in the morning, before meals. Since the hormonal background is unstable, three samples are taken at intervals of at least half an hour for accurate diagnosis. 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, adrenogenital syndrome.

The choice of treatment methods depends on the form of the pathology and the goal pursued by the therapy (combating hirsutism, restoring reproductive function, maintaining pregnancy in the event of a miscarriage).

The main treatment measures include:

drug therapy;
surgical intervention;
the 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 with the help of surgical intervention.

If a woman is not planning a pregnancy in the near future, but suffers from acne and excessive 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 contribute to the normalization of the menstrual cycle. For a cosmetic effect, anti-inflammatory ointments are prescribed, which reduce the production of sebum.

In the presence of contraindications to the use of contraceptives, Spironolactone is used for treatment. It is prescribed for severe premenstrual syndrome and with polycystic ovaries. The drug successfully treats acne and excessive hair growth.

The analogue drug is Veroshpiron. His main active substance is also spironolactone. Reception of Veroshpiron is highly undesirable without agreement with the doctor on the duration of use and the required dosage.

If hyperandrogenism is caused by the absence of an enzyme that converts androgens into glucocorticoids, agents are shown that normalize this process. Great efficiency possesses the drug Metipred. Forms of its release - 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 is determined by the doctor.

Drugs used to treat hyperandrogenism

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

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 consumed, which will lead to gradual decline weight.

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

Compliance with the principles of proper nutrition is supported by regular exercise. Running, aerobics, swimming, active outdoor games are useful.

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

The use of traditional medicine

Treatment with folk remedies is quite applicable in the complex of drug therapy, but is not a full replacement for traditional methods.

Popular recipes:

Herbs of sweet clover, sage, meadowsweet and knotweed are mixed in equal proportions, poured into 200 ml of water, kept in a water bath for 20 minutes and filtered. To the resulting broth, add 1.5 ml of tincture of Rhodiola rosea. Take a decoction of a third cup several times a day before meals.
2 tablespoons of chopped string, 1 tablespoon of yarrow and motherwort are poured with boiling water, insisted for about an hour, filtered. Take half a glass on an empty stomach in the morning and at bedtime.
A few tablespoons of dry nettle leaves are poured into a glass of water, insisted in a closed vessel, filtered. Take several times a day for a tablespoon.
Rose hips, blackcurrants are poured with boiling water, insisted for about an hour. Then some honey is added. The resulting cocktail is drunk several times a day after meals.

Among the most common folk remedies in the fight against diseases of the gynecological sphere - upland uterus. It is used in conjunction with others therapeutic agents in the form of a decoction or tincture.

Pour 100 g of boron uterus with 500 ml of vodka and infuse for 2 weeks. Tincture take 0.5 teaspoon three times a day.
Pour 2 tablespoons of boron uterus with a glass of boiling water, 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. Put the bottle with the mixture in a dark place for 14 days. After straining, take a teaspoon half an hour before meals.

Mint is used to reduce the amount of androgens produced. Based on it, tinctures and teas are prepared. For greater effectiveness, milk thistle can be added to mint. Regular intake of green tea normalizes female hormonal balance.

The attending physician will always tell you how to treat the problem with the help of medicinal herbs and combine this method with other types of treatment. Self-medication is unacceptable!

Hyperandrogenism and infertility

An excess of produced androgens often becomes an obstacle to a desired pregnancy.

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

Infertility treatment in this case is aimed at the use of drugs that stimulate the release of an egg from the ovaries. An example of such medicinal product maybe clomiphene.

One of the most effective drugs used to stimulate ovulation and normalize the menstrual cycle is Duphaston. After the onset of pregnancy, 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 method is widely used. During this procedure, the ovaries are excised to help the “exit” of a mature egg. The probability of getting pregnant after laparoscopy is the higher, the less time passes from the day of the operation. The maximum ability to conceive is noted in the first three months.

But even after a successful conception, the presence of hyperandrogenism can prevent the successful bearing of a child. An excess of male hormones often leads to the fact that the fetal egg cannot stay in the uterus. The chance 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 to lower 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 can harm the unborn baby. Many years of application experience 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 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:

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

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

In men and women, there are special hormones in the body that are responsible for sexual characteristics. In women, estrogens play the main role in this matter, and androgens in men. The pathology of the endocrine system can be manifested by an imbalance of sex steroids. So, an excess of male hormones in women provokes hyperandrogenism syndrome. Sometimes the development of this condition leads to excessive production of steroids in the body, sometimes - their high activity.

Androgens

The main androgen is testosterone. In addition, dihydrotestosterone, dehydroepiandrosterone, androstenedione, androstenediol, androsterone are synthesized in the human body. In men and boys, androgens are mainly produced by Leydig cells (in the testicles), in women and girls - in the adrenal cortex and ovaries.

The effect of testosterone on the body is very diverse and multifaceted.

Androgens affect metabolism. They increase the production of proteins, enhance all anabolic processes. Muscle strength and mass increase.

Thanks to these hormones, the utilization of glucose is enhanced. In the cells, the concentration of energy sources increases, and the level of blood glucose decreases.

Testosterone helps to reduce the percentage of adipose tissue in the body. Also, this hormone and its analogues affect the redistribution of subcutaneous fat (male type).

Androgens increase bone mineral density. They also help to reduce the level of atherogenic cholesterol fractions. However, their influence on lipid spectrum less blood than estrogens.

Testosterone is responsible for sexual activity. Libido in men and women is supported by androgens.

These hormones are involved in the formation of some behavioral responses. It is they who increase aggressiveness, decisiveness, rationality.

They are also responsible for the formation of male secondary and primary sexual characteristics:

formation of testicles, prostate, penis;
formation male type skeleton;
areola pigmentation;
increased sweating;
beard and mustache growth;
body hair growth;
coarsening of the voice;
baldness (in the presence of a genetic predisposition).

In girls and adult women, androgens are secreted in small quantities. At any age, the fair sex has a lower concentration of these hormones than men. The difference becomes noticeable even at the stage of intrauterine development. Hyperandrogenism in women can cause many pathologies.

Symptoms of androgen excess

If there are too many androgens, then the activity of the female reproductive system is disrupted. These changes can be pronounced, or they can be almost imperceptible. Signs of hyperandorogenia depend on the concentration of sex steroids and a number of other factors. The causes of the disease, the age of the patient, and heredity matter.

If there is a lot of testosterone, then there are signs of virilization. The woman becomes like a man. The earlier the disease is formed, the more changes are possible.

Symptoms of hyperandrogenism:

an increase in the clitoris in size;
enlargement of the outer and inner labia;
closer location of the labia;
atrophy (partial) of the mammary glands, appendages and uterus;
absence menstrual bleeding and maturation of eggs;
infertility.

If hyperandrogenism occurs during prenatal period, then a girl is born with external genitalia, reminiscent of male in structure. Sometimes for exact definition the gender of the child is required ultrasound diagnostics and genetic analysis.

If an excess of androgens is formed in childhood, then early puberty of the heterosexual type is likely.

In the event that testosterone is relatively small, but more than normal, then the adolescent observes abnormal puberty. There may be violations of the reproductive system. Also, girls are likely to:

the formation of the male physique;
coarsening of the voice;
development of acne;
hirsutism.

In adult women, hyperandrogenism syndrome can lead to the cessation of menstruation and ovulation. In such patients, the appearance may change - the waist circumference increases, the volume of the hips and buttocks decreases. However, male facial features and skeletal proportions are no longer formed.

If the woman is pregnant, then high concentrations testosterone and its analogues can provoke spontaneous abortion. A miscarriage in this case occurs due to the cessation of the increase in the size of the uterus.

The main symptom of hyperandrogenism

Most women are concerned about hirsutism - excess hair growth on the face and body. This is the most main symptom hyperandrogenism, forcing to seek medical help. The degree of hirsutism is determined by a special visual Ferriman-Gallway scale:

This scale does not take into account the growth of hair on the forearms and shoulders, since these zones are hormonally independent.

In addition to the manifestations of hirsutism, in a certain number of women, other symptoms of hyperandrogenism are not detected, but there are a large number of women in the family who suffer from this pathology. This is the so-called family (genetic) hirsutism, which does not require treatment.

When to see a doctor

Hyperandrogenism in women is one of the most common endocrine pathologies. With this problem, patients turn to different doctors. So, an endocrinologist, gynecologist, therapist, dermatologist, cosmetologist, trichologist, psychotherapist, sexologist can start the examination. Girls are examined by pediatricians, pediatric endocrinologists and gynecologists.

Women with hyperandrogenism turn to gynecologists because of various failures of the menstrual cycle, problems with conception and gestation.

Complaints about:

shortening of the menstrual cycle;
decrease in the abundance of secretions;
long intervals between menstruation;
absence of menstruation for more than six months (amenorrhea);
lack of pregnancy against the background of regular sexual activity.

Women come to cosmetologists (dermatologists, trichologists) because of many aesthetic problems. Patients are concerned about the condition of the skin of the face and body, excessive growth of body hair, baldness, sweating.

The most typical for hyperandrogenism:

hirsutism (hair growth in androgen-dependent zones);
the appearance of bald patches;
excessive formation of sebum;
acne
enlarged pores;
sweating.

Hirsutism is measured using the Ferriman-Gallway scale. The presence of hair and their density in 11 areas of the body are taken into account. These zones are androgen dependent. The higher the concentration of testosterone in the blood, the higher the hair growth in these areas.

Assess hair growth for:

chin
chest;
upper and lower back;
upper and lower abdomen;
shoulders
forearms;
shins;
thighs;
above the upper lip.

Women turn to endocrinologists because of changes in body proportions and metabolic disorders.

Patients come to psychotherapists and sexologists because of problems in the emotional and sexual spheres.

With hyperandrogenism, women may have complaints about:

aggressiveness;
irritability;
emotional lability;
hypersexuality;
pain during intercourse (the production of natural lubrication in the vagina decreases);
rejection of one's body, etc.

Why does hyperandrogenism occur?

Hyperandrogenism syndrome occurs for several reasons. First, the production of male sex steroids in the ovaries, adrenal glands, or other tissues may be increased. Second, women may be more sensitive to normal amount hormones.

Excessive synthesis of androgens occurs when:

congenital hypertrophy (dysfunction) of the adrenal cortex (VDKN);
tumors of the adrenal cortex (androstendinoma);
androgen-secreting ovarian tumor;
polycystic ovary syndrome;
Itsenko-Cushing's syndrome;
hypothalamic-pituitary dysfunction;
hyperinsulinism (as part of the metabolic syndrome);
stromal ovarian hyperplasia and hyperthecosis.

Hyperandrogenism of ovarian origin usually manifests itself at the time of puberty. Girls have characteristic cosmetic defects (acne, hirsutism), the menstrual cycle does not become regular even 2 years after menarche.

The cause of the formation of polycystic is considered heredity and wrong image life. Great importance has nutrition, physical and emotional stress in childhood. Especially important is the control of body weight, sleep and wakefulness in girls in prepubertal age (from 8 years old).

Adrenal hyperandrogenism is congenital or acquired.

VDKN is caused by a violation of the synthesis of steroids. In severe cases, this developmental anomaly can lead to the death of a newborn child (both girls and boys). If VDKN proceeds latently, then its signs are found only in adulthood.

Adrenal hyperandrogenism due to HCHD is usually associated with a deficiency of the 21-hydroxylase enzyme. In newborn girls with this pathology, irregular structure external genitalia. Babies also show acidification internal environment body (decrease in blood pH).

VDKN can also be caused by a deficiency of other enzymes of steroidogenesis (for example, 11β-hydroxylase and 3β-hydroxysteroid dehydrogenase).

Adrenal hyperandrogenism due to tumors can be diagnosed at any age. If the neoplasm has signs of malignancy, then the prognosis for health is unfavorable. Testosterone-secreting ovarian tumors can also be malignant or benign. Any such neoplasms require surgical treatment.

Hyperandrogenism of mixed genesis is detected in women with hypothalamic (neuroexchange endocrine) syndrome. In such patients, the encephalogram (EEG) reveals violations of the bioelectrical activity of the brain. AT clinical practice this syndrome manifests itself autonomic disorders and multiple dysfunction of the endocrine glands (including the adrenal glands and ovaries).

Diagnostics

If a girl or adult woman there are symptoms of androgen excess, then she is prescribed an examination.

The plan for diagnosing hyperandrogenism includes:

blood tests;
tomography;

Laboratory samples should include studies of hormones and biochemical parameters.

From sex steroids in the blood determine:

free testosterone, total;
17-OH-Progesterone;
dehydroepiandrosterone sulfate.

Also, for diagnosis, it is necessary to clarify the concentration:

sex-binding globulin;
gonadotropins (LH and FSH);
estrogen;
insulin;
glycated hemoglobin;
cortisol, etc.

Ultrasound and tomography are needed to detect organ hypertrophy or neoplasms. In women, the structure of the ovaries, uterus, tubes, adrenal glands, pituitary gland and hypothalamus is evaluated.

When all the necessary information is collected, the doctor determines the cause of hyperandrogenism and prescribes the necessary treatment.

Treatment of the syndrome

Excess testosterone and other androgens can be eliminated with medication or surgery. Treatment for hyperandrogenism depends on the cause of the disease.

Ovarian hyperandrogenism due to polycystic syndrome is amenable to conservative treatment. Patients are prescribed combined oral contraceptives, spironolactone, glucocorticosteroids, ketoconazole. If this does not help, then a wedge resection or laparoscopic coagulation of the ovaries is performed.

CVD is treated with steroids. Patients are prescribed dexamethasone. This drug suppresses the excess secretion of androgens in the adrenal glands.

Androgen-secreting tumors of the ovaries and adrenal glands are treated promptly. Surgical intervention most often necessary for stromal ovarian hyperplasia and hyperthecosis.

Hyperandrogenism is a pathology in which the hormonal background of a woman undergoes significant changes. There is too much production a large number androgen hormone, which is considered male. In the body of a woman, this hormone performs many necessary functions, but its excessive amount leads to backfire for which treatment is required.

Androgens are produced in women by adipocytes, adrenal glands and ovaries. These sex hormones directly affect the process of puberty in women, the appearance of hair in the genital area and armpits. Androgens regulate the functioning of the liver, kidneys, and also affect muscle growth and the reproductive system. They are necessary mature women, since they synthesize estrogen, maintain a sufficient level of libido and strengthen bone tissue.

What is hyperandrogenism?

Hyperandrogenism in women, its manifestations and consequences photo

Hyperandrogenism is a pathological condition that most often leads women to amenorrhea (complete absence of menstruation) and infertility. Ovarian follicles in women are surrounded by cell layers, and an excess of androgens prevents follicular growth, as a result, follicular atresia (overgrowth of follicles) occurs. In addition, with an excess amount of male hormones, fibrosis of the ovarian capsule develops, which in turn leads to polycystic disease (many cysts on the ovaries).

To master the mechanism of development of hyperandrogenism in women, you should remember:

The hypothalamus is the central regulatory department in the brain of the head, which controls metabolic processes in the human body; is responsible for the functionality of the endocrine and gonads. It is a place of interaction between two important systems such as nervous and hormonal;
The pituitary gland is the main endocrine gland which is located in the brainstem of the head. Responsible for the operation of the system hormonal metabolism under the direction of the hypothalamus;
Violations central genesis- these are regulatory disorders in the brain, appear from incorrect operation pituitary and hypothalamus;
The adrenal glands are two small endocrine glands that are located above the kidneys. They consist of two layers - the inner cerebral and outer cortical;
A test to determine the source of hyperandrogenism, using dexamethasone - through the introduction of this drug, the level of androgens in the blood in women is determined

Ovarian damage and how to deal with them

Hyperandrogenism of ovarian origin is found in 4-5% of women at the age of reproduction. The variety of causes does not make it possible to accurately determine the conditionality of its occurrence, however, a key link in the pathogenesis of the syndrome has been identified - these are the main and secondary regulatory failures in the work of the hypothalamus - pituitary system. These failures cause excessive stimulation of LH production or lead to an increased ratio of gonadotropic hormones LH / FSH.

A relatively large or excessive amount of LH leads to hyperplasia of the connective tissue protein membrane of the ovaries, the outer and granular layer of the follicles. Because of this, the amount of ovarian androgens increases, signs of masculinization become visible. Insufficient FSH production leads to the fact that the follicles do not mature, the woman begins annovulation, requiring treatment.

The reasons are heavy loads and excess male hormones

Medical scientists suggest that ovarian hyperandrogenism occurs due to:

relative or unconditional excess of LH, which has arisen due to improper functioning of the adenohypophysis or hypothalamus;
excessive synthesis of male sex steroid hormones by the adrenal cortex in the prepubertal period;
accumulation excess fat at prepubertal age. Obesity is believed to be the dominant risk factor, since androgens are predominantly converted into estrogens in fat;
insulin resistance and hyperinsulinemia;
due to impaired steroid genesis in female ovaries. In some patients, there is an intense production of 17alpha-hydroxylase, an enzyme that converts 17-hydroxypregnenolone to DHEA and 17-hydroxyprogesterone to steroid hormone androstenedione;
primary hypothyroidism

Polycystic ovaries in women can appear with non-classical congenital adrenal hyperplasia.

Other causes of hyperandrogenism include androgen-secreting neoplasms on the ovaries (requiring surgical treatment), hyperthecosis and leidigoma.

Symptoms include excessive hair growth on the skin

Symptoms of hyperandrogenism can be basic:

active hair growth in a woman's limbs and other parts of the body (abdomen, mammary glands). Hair begins to grow on the cheeks - this type of hair growth is called hirsutism;
bald patches on the head (alopecia);
defects appear on the face, in the form of blackheads, pimples, peeling and various inflammations(treatment by a cosmetologist does not give results);
osteoporosis develops, muscle atrophy is observed;

Hyperandrogenism syndrome in women has secondary manifestations (depending on the stage and causes of the disease):

increased blood glucose levels (type 2 diabetes);
a sharp set of excess weight (obesity that needs to be treated);
the formation of the genital organs in women according to an intermediate type;
the woman never menstruates or the cycle is separated by significant intervals;
infertility or miscarriage of the fetus, if hyperandrogenism occurs during pregnancy (for the successful bearing of the fetus, the woman's body needs female hormones in a certain amount, and with hyperandrogenism they are practically not produced);
bouts of hypertension

Women suffering from hyperandrogenism often catch colds, are prone to depressive states, rapid fatigue. The age of the patient is not important - hyperandrogenism can be ill at absolutely any age period of life, starting at birth itself.

Diagnosis consists in examining a doctor, identifying the causes of the disease

At the beginning of the examination of a woman, the doctor first of all tries to exclude diseases that are accompanying: hepatic diseases, sexual differentiation, Cushing's syndrome, androgen-secreting tumor formations on the adrenal glands.

Diagnosis of hyperandrogenism in women in a clinical laboratory:

Definition of main hormonal level. Find out what is the amount of prolactin, free and total testosterone, dehydroepiandrosterone sulfate, androstenedione and FSH levels in blood plasma. The material is taken in the morning, on an empty stomach. Due to the constant changes in the hormonal background, patients with hyperandrogenism are tested three times, with intervals of 30 minutes between procedures, then all three portions of the blood are mixed. Dehydroepiandrosterone sulfate, in an amount of more than 800 μg%, indicates the presence of an androgen-secreting tumor of the adrenal glands;
The amount of ketosteroids-17 in urine is determined;
They take a marker to determine hCG (in the case when there are signs of hyperandrogenism, but the main level of androgens remains normal).

Instrumental examination: a patient with suspected hyperandrogenism is referred for MRI, CT, intravaginal ultrasound (to visualize tumor formations).

Treatment is made various drugs depending on the shape and wishes of the woman

Depends on the personal desires of a woman with hyperandrogenism:

if children are expected in the future, then treatment is with clomiphene;
if a woman does not plan to restore fertility functions, then she is prescribed hormone treatment ( oral contraceptives). At high content LH (after two months of taking the drugs) androstenedione and testosterone levels return to normal;
if a woman is contraindicated contraceptives, then she is prescribed spironolactone for treatment. The course of treatment is six months.
tumors on the ovaries are removed promptly

The adrenal form in 95% is congenital, its treatment should be accurate and of high quality.

Adrenal hyperandrogenism is more often congenital. Masculine symptoms in this case appear early. The first menstruation in women appears very late, and in the future they can either become very rare or stop altogether. With adrenal hyperandrogenism, all patients have abundant acne on the back and chest, local pigmentation of the skin.

In women, hypoplasia of the mammary glands is noted, the figure develops according to the male type (pelvis is narrow, shoulders are wide). With adrenal hyperandrogenism, the woman's clitoris is somewhat hypertrophied, the uterus becomes smaller, but the ovaries remain of normal size.

Diagnosis and treatment of hyperandrogenism in women requires maximum accuracy. In case of adrenal hyperandrogenism, treatment with glucocorticoids is recommended. medicines to maintain normal hormonal levels.