Hyperandrogenism in women is a complete cure. Problems of the female reproductive system - hyperandrogenism syndrome

Hyperandrogenism is a pathological condition that occurs in girls and women, and is characterized by an increased level of androgens in the body. Androgen is considered a male hormone - it is also present in the female body, but in a small amount, therefore, when its level increases, a woman has characteristic symptoms, including the cessation of menstruation and infertility, male pattern hair and some others. Change hormonal background requires urgent correction, as this can cause the development of many pathologies in a woman's body.

Androgens are produced by the ovaries, adipocytes, and adrenal glands. And they affect not only some external manifestations, but also the functioning of internal organs, including the kidneys, liver, reproductive system, musculoskeletal system.

Varieties and causes

Depending on which organ begins to produce a large amount of androgens, there are several forms of this pathological condition. The most common form is ovarian hyperandrogenism in which excess hormones are produced by the ovaries. This is usually associated with pathologies such as polycystic ovaries or organ tumors that can produce androgens.

Most often, this form of pathology is hereditary in nature - if an increase in androgen production was observed in the mother, then it is highly likely that the disease will manifest itself in her offspring. Accumulating, androgens cause the development of such a pathological condition as hyperandrogenism. Also, the reasons for the development of this form of hyperandrogenism may lie in the disruption of the hypothalamus and pituitary gland, which are responsible for the normal hormonal background of the female body.

The second form is adrenal hyperandrogenism, which can occur in girls as early as early age. The reasons for the development of this form are the lack of enzymes that ensure the production of adrenal hormones.

The central form of pathology develops in cases where the pituitary gland or hypothalamus is affected by a tumor. But there is also more peripheral form, which arises as a consequence diabetes and disorders of fat metabolism.

The most frequently occurring is mixed hyperandrogenism, which is caused by several violations at once. This may be adrenal hyperandrogenism and a violation of ovarian origin or ovarian and central genesis etc.

Hyperandrogenism and pregnancy

As mentioned above, hyperandrogenism can cause girls and. But there are such exceptional cases when a woman with such a pathology can still become pregnant, and then she should be prepared for the fact that hyperandrogenism during pregnancy mainly ends in involuntary miscarriage. In cases where a miscarriage has not occurred, there is a high probability of the fetus freezing in the womb with the need for mechanical cleaning of the uterine cavity for its evacuation.

All this adversely affects the health of women and further exacerbates the problem. hormonal imbalance, so that this does not happen, the diagnosis of hyperandrogenism should be carried out before conception, so that later, after treatment, the woman has a chance to become the mother of a beautiful baby.

Of course, not in all cases of hyperandrogenism and normal pregnancy are incompatible concepts - if hormonal disorders developed in the later stages, there is a risk of premature birth, but the baby will be healthy. Therefore, it is very important to register in a timely manner women's consultation- the doctor can not only determine the pathology on early dates, but also successfully treat it, giving the woman the opportunity to bear the child.

Symptoms

As mentioned above, the syndrome of hyperandrogenism in girls can be determined at a very young age. These are symptoms of hormonal imbalance, such as:

clitoral hypertrophy;
partial fusion of the labia majora;
increased male pattern hair (middle abdomen, chin and cheeks, chest.).

In girls who suffer from this disease in adolescence, menstruation does not begin, and if the disease occurs in women, the menstrual cycle stops. Other symptoms of a pathology such as hyperandrogenism are:

hair loss on the head;
appearance skin rashes on the face and body (like acne);
pronounced dryness skin, peeling.

Also, girls and women have metabolic disorders, most often manifested at various stages, as well as muscle atrophy. In some cases female voice can coarsen and become like a man - most often this symptom occurs in adult women. If hyperandrogenism in women develops in young age, there is a high probability that their muscle corset will increase, due to which the body will acquire a courageous relief and a large muscle mass.

Of course, there are also common symptoms of a pathological condition in women. These include:

irritability;
fatigue;
susceptibility to infections due to reduced immunity, etc.

Diagnosis and treatment

Make a diagnosis based on external manifestations pathology is not possible. Therefore, the doctor prescribes laboratory tests for patients to assess the hormonal background, including the level of androgens. An ultrasound examination is also shown, which will give the specialist the opportunity to identify the causes of the disease, without which effective treatment impossible.

Treatment depends on the form of the pathology found in the woman. In particular, if she has ovarian hyperandrogenism, antiandrogenic oral contraceptives are indicated. And for the disposal of excess hormones, the use of drugs such as Metipret and Dexamethasone is shown. These tools raise the level female hormones, and those, in turn, utilize the surplus of men.

When a tumor becomes the cause of the development of pathology, it is required prompt removal with subsequent treatment, which will be selected for the patient individually in each case.

If girls or women are diagnosed with adrenal hyperandrogenism, then its treatment will consist in the appointment of glucocorticoid hormones - the same Dexamethasone described above. Note that the easiest way to treat a disease of ovarian origin, since modern pharmaceutical industry offers a large number of products that can stabilize the hormonal background of a woman. adrenal hyperandrogenism and mixed form pathologies are more difficult to treat, and the fair sex is required for a long time (or even a lifetime) to use drugs prescribed by a doctor.

Treat the disease folk methods possible, but their effectiveness is very low. However, there are some herbs that have a hormone-stabilizing effect, so if you drink them in the form of infusions and decoctions, they can slightly improve the condition of a woman. True, pathology can be treated in this way only after consultation with a specialist.

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The most noticeable symptom of hyperandrogenism is hirsutism, but it must be remembered that it is not always due to hyperandrogenemia (for example, it can be constitutional). Conversely, an excess of androgens is not necessarily accompanied by severe hirsutism - as, for example, in Asian women with polycystic ovary syndrome.

Synthesis of androgens in women

Androgens are C19 steroids that are secreted from cholesterol in the reticular zone of the adrenal cortex, as well as in thecocytes and stroma of the ovaries. In addition, these bodies and peripheral tissues androgens can be converted into more active derivatives (for example, testosterone - into dihydrotestosterone), into estrogens (under the action of aromatase) or inactivated by conjugation with glucuronic acid or sulfation and subsequently excreted from the body.

Androgens act both systemically (classic endocrine regulation) and locally (paracrine or autocrine regulation, for example, in skin hair follicles). They bind to intracellular androgen receptors located in the cytoplasm. Then the hormone-receptor complex moves to the nucleus, where, in the course of a complex interaction with other transcription factors and coactivator proteins, it regulates the transcription of target genes. In addition, androgens can act indirectly, through metabolites (for example, through electrogens).

In plasma, androgens circulate in combination with a number of proteins, primarily with SHBG. Compared to the latter, albumin has a much higher binding capacity due to its higher concentration and greater total amount. However, the affinity of androgens for albumin is much lower, so the bulk of plasma testosterone circulates in combination with SHBG. In such a complex, androgens are less biologically available to target cells than in a complex with albumin. SHBG is produced by the liver. Estrogens, including those taken orally, stimulate the production of this protein, while androgens, and, most importantly, insulin, inhibit it. Therefore, women with hyperandrogenism and men have lower levels of SHBG. Androgens are metabolized in the liver and other peripheral tissues, and their metabolism is highly dependent on the level free hormones in plasma.

The production of androgens depends on age and the presence of obesity. With age, the level of adrenal androgens, especially dehydroepiandrosterone, its metabolite (dehydroepiandrosterone sulfate) and androstenedione, gradually decreases; this decline begins even before menopause. Age affects testosterone levels to a lesser extent; the ovaries continue to produce this hormone in fairly large amounts even after menopause.

Symptoms and signs of hyperandrogenism

The clinical manifestations of hyperandrogenism are varied; they are caused by the action of androgens on the hair follicles and sebaceous glands(hirsutism, acne vulgaris, androgenetic alopecia) and on the hypothalamic-pituitary-ovarian system (ovulation and menstrual cycle disorders). In severe hyperandrogenism, other signs of virilization develop.

Clinical manifestations of hyperandrogenism

Hair follicles and sebaceous glands

hirsutism
Acne vulgaris A
androgenetic alopecia

Hypothalamic-pituitary-ovarian system

Ovulation disorders
Oligomenorrhea
Dysfunctional uterine bleeding
Infertility caused by anovulation

Adipose tissue

Obesity by male pattern

virilization

Severe hirsutism
Androgenetic alopecia
Low voice
Clitoral hypertrophy
Obesity by male pattern
Increase muscle mass
Breast reduction

Effects on hair follicles and sebaceous glands

In androgen-dependent zones instead of thin, colorless vellus hair coarse, thick, pigmented terminal hairs begin to grow. The effect of androgens on peripheral tissues depends mainly on the activity of 17p-hydroxysteroide dehydrogenase (turns androstenedione into testosterone) and 5α-reductase and on the number of androgen receptors. Before puberty, mainly thin, short, colorless vellus hair (velus) grows on the body. IN puberty an increase in androgen levels causes some of these hairs to be replaced by coarser, longer, pigmented terminal hairs. It should be noted that the terminal hairs of the eyebrows, eyelashes, occipital and temporal parts of the head depend little on androgens.

Acne vulgaris

Androgens stimulate the production of sebum and keratinization of the walls of the follicle, which contributes to the development of seborrhea, folliculitis and acne during puberty and with hyperandrogenism. In patients with acne vulgaris, plasma androgen levels and 5a-reductase activity, which converts testosterone to dihydrotestosterone, are elevated. Therefore, with the appointment of antiandrogens, COCs or glucocorticoids, improvement often occurs.

Androgenetic alopecia

An excess of androgens, which stimulates the growth of hair on the face and trunk, on the hair follicles of the scalp, on the contrary, acts in the opposite way: the hair follicles decrease in size, instead of terminal hair, hair similar to fluff begins to grow. Androgenetic alopecia occurs in both men and women. In women, it can proceed in two ways. With severe hyperandrogenism and virilization symptoms, hair loss is observed on the parietal part of the head, a change in the front edge of hair growth with the formation of bald patches. But more often baldness comes down to thinning hair, mainly in the parietal region. Approximately 40% of women with androgenetic alopecia find hyperandrogenism, but if we take into account cases of isolated alopecia without hirsutism, this figure will decrease to 20%.

Effect on ovarian function

Hyperandrogenism is often accompanied by ovulation disorders, either due to a violation of the secretion of gonadotropic hormones, or as a result of the direct action of androgens on the ovaries. Androgens affect the hypothalamic-pituitary system and the secretion of gonadotropic hormones in women indirectly (after being converted into estrogens) or directly. In the experiment, dihydrotestosterone disrupted the ability of progesterone to control the frequency of GnRH impulses, which led to an increase in LH secretion. In addition, an excess of androgens can inhibit the maturation of ovarian follicles, resulting in the appearance of multiple small cysts in the cortex (so-called polycystic ovaries). The clinical manifestation of ovarian dysfunction in hyperandrogenism is menstrual irregularities, which can be considered as a symptom of androgen excess even in the absence of anrogen-dependent skin lesions.

Effect on the adrenal glands

25-50% of women with hyperandrogenism have elevated levels of adrenal androgens (eg, dehydroepiandrosterone and its sulfate). However, an increase in adrenal steroidogenesis and an increase in adrenal androgens may be due, at least in part, to extraadrenal (eg, ovarian) androgens. Elevated levels of dehydroepiandrosterone sulfate in women with polycystic ovary syndrome are reduced by 20-25% after the appointment of GnRH analogs long-acting, although the normalization of the level of adrenal androgens against the background of such treatment is rarely observed. The secretion of adrenal androgens, especially dehydroepiandrosterone sulfate, can be increased with an excess of extra-adrenal androgens, further exacerbating hyperandrogenism.

Obesity

Obesity and hyperandrogenism are closely related, especially in polycystic ovary syndrome. It is not known which of these conditions develops first. In polycystic ovary syndrome, the amount of androgens that can be converted to estrogens in peripheral tissues increases, resulting in an increase in estradiol levels. In a prospective study, ten normal-weight young men undergoing female-to-male gender reassignment surgery underwent MRI scans: before testosterone, after a year of taking the drug, and after three years of taking the drug. In the course of treatment, the weight changed slightly, but the distribution of subcutaneous adipose tissue changed significantly. After a year of treatment, her thickness in the abdomen, pelvis, and thighs decreased significantly compared to baseline, but after three years of treatment, these differences were no longer statistically significant. The mass of adipose tissue of the internal organs, on the contrary, practically did not change in the first year of treatment, although it increased in those who gained weight during this period. However, after three years of testosterone supplementation, this figure increased by 47% compared to baseline, and, as before, it was highest in those who gained weight.

All these data confirm that an excess of androgens or estrogens formed from them contributes to the development of male-type obesity, which leads to an increase in insulin resistance and a further increase in androgen levels in patients with hyperandrogenism. An indirect effect of androgens on weight gain through the central nervous system is not excluded. The role of androgens in the development of obesity is not entirely clear, but in favor of their influence is the fact that among men the prevalence of overweight is higher than among women.

Anabolic action of androgens and virilization

With severe and prolonged hyperandrogenism, virilization can be observed - the appearance of bald patches in the parietal part of the head and above the forehead, clitoral hypertrophy and severe hirsutism. In the future, especially if hyperandrogenism has developed before the onset of puberty, the physique (atrophy of the mammary glands, an increase in muscle mass) may change and the timbre of the voice may decrease. Among women childbearing age virilization is almost always accompanied by amenorrhea. Most often, virilization indicates an androgen-secreting tumor. Moderate virilization also occurs in girls with severe insulin resistance (eg, with HAIR-AN syndrome).

Rare causes of hyperandrogenism

The clinical picture of hyperandrogenism is also observed in ACTH-secreting tumors - pituitary adenoma (Cushing's disease) or an ectopic tumor. However, Cushing's syndrome is extremely rare (1:1,000,000), and methods for its detection do not have one hundred percent sensitivity and specificity, so it is not necessary to examine all women with hyperandrogenism for Cushing's syndrome. Occasionally, hyperandrogenism can also be a consequence of the ingestion of androgens. In pregnancy, severe hirsutism or even virilization may have a benign ovarian cause such as thecalutein cysts, pregnancy luteomas, or the extremely rare aromatase deficiency, in which the placenta is unable to synthesize estrogens from androgens, resulting in hyperandrogenism.

Examination for hyperandrogenism

To establish the cause of hyperandrogenism, first of all, anamnesis and physical examination are important, while laboratory studies are necessary mainly in order to confirm or refute the various diagnoses that arise during the examination.

Examination for suspected hyperandrogenism

Anamnesis

Taking medications or other androgen-containing drugs
Skin exposure to irritants
Information about the menstrual cycle, pregnancy and childbirth
Time of onset and progression of hirsutism, acne, and alopecia
Enlargement of the limbs or head, changes in the contours of the face, weight gain
Lifestyle information (smoking, drinking)

Physical examination

Assessment of hirsutism, such as the modified Ferriman-Galloway scale
Androgenetic alopecia
Black acanthosis and soft fibromas
Signs of Cushing's Syndrome
Obesity and its type
Clitoral hypertrophy
Other signs of virilization

Laboratory research

TSH (measured by a highly sensitive method)
17-hydroxyprogesterone in the follicular phase of the menstrual cycle
Prolactin
Total and free testosterone, dehydroepiandrosterone sulfate (usually in cases where symptoms of hyperandrogenism are mild or questionable)
Fasting and postprandial insulin levels

Anamnesis

Collect a detailed history: taking drugs and other drugs containing androgens: exposure to the skin of irritants; data on the menstrual cycle, pregnancy and childbirth; time of onset and progression of hirsutism; an increase in the size of the limbs or head, a change in the shape of the face, weight gain; the presence of bald patches, hair loss and acne; find out also whether there are similar diseases in the next of kin. Diabetes in the next of kin is an important predictor of β-cell dysfunction in a patient. History should also include lifestyle information (smoking, drinking).

Physical examination

Pay attention to the signs of Cushing's syndrome, the presence of black acanthosis, bald patches, acne, the nature and distribution of hair on the body. The scale for assessing the degree of hirsutism is widely used, which is a modification of the scale proposed in 1961 by Ferriman and Gallway. Look for signs of virilization and masculinization (as a rule, they are clearly visible). Clitoral hypertrophy is usually referred to if the product of the longitudinal and transverse diameters of the clitoral head exceeds 35 mm 2 (normally both diameters are approximately 5 mm). Pay attention to the signs of insulin resistance: obesity, especially male type, the presence of acanthosis nigricans and soft fibromas. In women with male-type obesity, dyslipoproteinemia is noted, which is increased compared to obesity in terms of female type insulin resistance, more high risk cardiovascular disease and higher overall mortality. The type of obesity is most easily assessed by waist circumference, measured at the narrowest part of the abdomen, usually just above the navel. Waist circumference in women greater than 80 cm indicates the presence of excess visceral fat and is considered a deviation from the norm, although morbidity and mortality increase markedly at an indicator of 88 cm or more.

Laboratory research

The goal is an exception certain diseases with similar manifestations and, if necessary, confirmation of hyperandrogenism. In addition, the presence of metabolic disorders is detected. Diseases that should be ruled out if hyperandrogenism is suspected - pathology thyroid gland, hyperprolactinemia, HAIR-AN syndrome, and androgen-secreting tumors. Thyroid pathology is excluded by determining TSH level using a highly sensitive method.

As already mentioned, even if a patient with hirsutism claims that her menstrual cycle is regular, you need to make sure that there are no ovulation disorders; usually make a chart of basal temperature. With ovulation disorders, polycystic ovary syndrome is possible. It is also necessary to determine the level of prolactin to rule out hyperprolactinemia, and the level of insulin and fasting glucose to rule out HAIR-AN syndrome.

Identification of metabolic disorders

Metabolic abnormalities are common in PCOS, but always in HAIR-AN syndrome. In HAIR-AN syndrome, the presence of insulin resistance is obvious, but in polycystic ovary syndrome this is not always the case. Unfortunately, there are no accurate, inexpensive, and reproducible assays for assessing insulin sensitivity in routine practice. In research settings, stimulation and suppression tests, such as the euglycemic test, and intravenous glucose tolerance testing with frequent blood sampling are commonly used, but they are rarely used in routine examination of patients with hyperandrogenism.

Radiation diagnostics

Ultrasound of the small pelvis with hyperandrogenism allows you to clarify the presence of anovulatory disorders and polycystic changes in the ovaries. It must be remembered that polycystic ovaries can be found in many diseases that cause hyperandrogenism, and not only in polycystic ovary syndrome. The value of ultrasound using a vaginal probe increases with obesity, since it is difficult to identify pathological formations in the ovaries in such women during examination.

If an androgen-secreting tumor is suspected, CT or MRI of the adrenal glands is indicated to exclude an adrenal tumor larger than 5 mm and to detect bilateral adrenal hyperplasia in the case of an ACTH-secreting tumor. However, since 2% of the population has asymptomatic adrenal adenomas (detected by chance), the discovery of a tumor does not always mean an androgen-secreting tumor and may provoke invasive and unnecessary procedures. Therefore, CT and MRI of the adrenal glands are performed only when the symptoms clearly indicate an adrenal cause. IN rare cases in order to establish the localization of an androgen-secreting tumor, selective catheterization of the adrenal veins or scintigraphy with,3β-cholesterol is performed.

Treatment of hyperandrogenism

Treatment of hyperandrogenism is mainly symptomatic.

It has four main goals:

normalization of the menstrual cycle;
elimination of skin manifestations;
elimination and prevention of concomitant metabolic disorders;
treatment of infertility caused by anovulation.

Treatment methods are aimed at suppressing the synthesis of androgens, blocking their peripheral action, correcting insulin resistance and dyslipoproteinemia (if any), eliminating skin manifestations of the disease using local, mechanical or cosmetics. In most cases, several methods are used. Ways to normalize the menstrual cycle and eliminate skin manifestations, primarily hirsutism, are discussed below.

Main goals in the treatment of hyperandrogenism

Regulation of the menstrual cycle

Glucocorticoids
Lifestyle changes

Elimination of skin manifestations (hirsutism, acne, alopecia)

Decreased androgen levels
Long acting gonadoliberin analogues
Androgen receptor blockers
Spironolactone
Flutamide
Cyproterone
5α-reductase inhibitors
Finasteride
Suppression of hair growth with local remedies
Ornithine decarboxylase inhibitors
Mechanical and cosmetic methods of hair removal
Electrolysis
Laser Hair Removal
Cosmetic procedures (shaving, chemical hair removal, bleaching)

Elimination and prevention of concomitant metabolic disorders

Drugs that increase insulin sensitivity
Lifestyle changes

Treatment of infertility caused by anovulation

Clomiphene
Preparations of gonadotropic hormones
Gonadoliberin analogues in pulsed mode
Surgery (coagulation of the ovaries)
Lifestyle changes

Normalization of the menstrual cycle

Normalization of the menstrual cycle reduces the risk of dysfunctional uterine bleeding and the anemia caused by these disorders. As a rule, COCs, progestogens are prescribed in a cyclic or continuous mode.

Combined oral contraceptives

COCs reduce the level of gonadotropic hormones and, consequently, the production of ovarian androgens. The estrogens contained in COCs simulate the synthesis of SHBG and, as a result, reduce the level of free testosterone. Progestogens in COCs can inhibit 5α-reductase and block the binding of androgens to receptors. Finally, COCs are able to suppress the synthesis of adrenal androgens, although the mechanism of this action is not yet clear. COCs normalize the menstrual cycle and reduce the risk of endometrial hyperplasia and cancer of the uterine body with hyperandrogenism of any origin. It is best (although not necessary) to choose a COC containing a progestogen with antiandrogenic action: cyproterone, chlormadinone (Belara), dienogest, drospirenone. When COCs are used by women with polycystic ovary syndrome, activation of the renin-angiotensin-aldosterone system can negatively affect metabolism, and in this regard, drugs such as Midiana and Dimia, which include drospirenone, which, in addition to antiandrogenic, antimineralocorticoid activity, have certain advantages. Endogenous progesterone, the deficiency of which is inevitable in anovulatory conditions, has a small antiandrogenic and antimineralo-corticoid effects.

Although it has not been specifically studied, it has been observed that COCs containing 30-35 micrograms of ethinyl estradiol are usually less likely to lead to breakthrough bleeding. This statement does not apply to adolescents, who are more sensitive to sex steroids than adult women. Microdoses of ethinyl estradiol are better tolerated, but skipping a tablet of such a COC is more likely to lead to ineffective contraception.

Cyclic or continuous use of progestogens

It is also possible to normalize the menstrual cycle with hyperandrogenism, especially in the case of amenorrhea, by prescribing progestogens in a cyclic mode. Since sometimes progestogens can stimulate ovulation, and since not all patients ovulate completely, women leading sexual life, it is better to prescribe micronized progesterone (100-200 mcg twice a day) or dydrogesterone (10 mg twice a day) orally, rather than synthetic progestogens, derivatives of nortestosterone.

Drugs that increase the sensitivity of peripheral tissues to insulin

Originally developed for the treatment of type 2 diabetes, these drugs are now also used for polycystic ovary syndrome. These include metformin and thiazolidinedione derivatives. Encouraging results have also been obtained for a number of other drugs (for example, acarbose).

Metformin

Metformin, a biguanide, inhibits gluconeogenesis in the liver. Side effects - diarrhea, nausea and vomiting, bloating, flatulence, loss of appetite - they are observed in 30% of cases. In rare cases, lactic acidosis may develop; in predisposed persons, it can be provoked by the intravenous administration of iodine-containing radiopaque agents, although this mainly happens with decompensated diabetes mellitus or impaired renal function. In polycystic ovary syndrome, metformin normalizes the menstrual cycle, leading to regular menstruation, according to various sources, in 40 or even 100% of cases. There are several explanations positive impact metformin on steroidogenesis: a decrease in CYP17 activity, suppression of androstenedione production due to a direct effect on thecocytes, a decrease in FSH-stimulated activity of 3β-hydroxysteroid dehydrogenase, the level of StAR protein, and CYP11A1 activity in granulosa cells. The molecular mechanisms of action of metformin on the ovary are not fully understood, but recent studies have shown that metformin increases the expression of AMP-activated protein kinase in granulosa cells. The use of metformin leads to a decrease in the level of androgens and, with a duration of therapy of at least 6 months, anti-Müllerian hormone. Interestingly, a significant decrease in the level of anti-Müllerian hormone was observed in women in whom a regular menstrual cycle was restored during metformin therapy, while the ineffectiveness of metformin was associated with the maintenance of an increased concentration of anti-Müllerian hormone. In polycystic ovary syndrome, metformin is taken at a dose of 1500-2000 mg / day, although in 15-30% of cases complications from the gastrointestinal tract may develop. Initial administration of metformin at a lower dose and then gradually increased to the full dose over 2-4 weeks, as well as use in the form of long-acting drugs, may reduce the incidence of side effects.

Thiazolidinedione derivatives

Thiazolidinedione derivatives are PPAR-γ receptor agonists (nuclear receptors activated by peroxisome inducers).

Thiazolidinediones (pioglitazone) and metformin have been compared in randomized controlled trials. The effect of these drugs on fasting plasma glucose levels, testosterone levels, Ferriman-Galloway score did not significantly differ, however, metformin, unlike pioglitazone, was accompanied by weight loss.

Weight loss

According to preliminary data, the type of diet (for example, 15-25% carbohydrates instead of 45%) is less important compared to the total calorie content. However, a low-carbohydrate (25%) diet is better at normalizing fasting insulin levels, glucose-to-insulin ratios, and triglycerides and appears to be the preferred diet for those with insulin resistance. Clear recommendations regarding dietary preferences in PCOS can only be made after prospective studies.

Surgical intervention

Ovulatory function can be normalized after wedge resection or laparoscopic coagulation of the ovaries and persist for 10-20 years. But if a woman does not aspire to have a baby, with polycystic ovary syndrome, laparoscopic coagulation does not have any particular advantages over taking COCs and currently as a method of normalizing the menstrual cycle not used.

Hyperandrogenism in women is a collective term that includes a number of syndromes and diseases accompanied by an absolute or relative increase in the concentration of male sex hormones in a woman's blood. Today, this pathology is quite widespread: according to statistics, 5-7% of adolescent girls and 10-20% of women of childbearing age suffer from it. And since hyperandrogenism entails not only various defects in appearance, but is also one of the causes of infertility, it is important for women to have an idea about this condition so that, having noticed in themselves similar symptoms immediately seek help from a specialist.

It is about the causes of hyperandrogenism in women, about its clinical manifestations, as well as how the diagnosis is made, and about the tactics of treating this pathology, you will learn from our article. But first, let's talk about what androgens are and why they are needed in the female body.

Androgens: the basics of physiology

Androgens are male sex hormones. The leading, most famous representative of them is testosterone. In the body of a woman, they are formed in the cells of the ovaries and the adrenal cortex, as well as in the subcutaneous adipose tissue (SAT). Their production is regulated by adrenocorticotropic (ACTH) and luteinizing (LH) hormones synthesized by the pituitary gland.

The functions of androgens are multifaceted. These hormones:

are precursors of corticosteroids and estrogens (female sex hormones);
form sex drive women;
growth during puberty tubular bones, and hence the growth of the child;
participate in the formation of secondary sexual characteristics, namely, female type hair.

Androgens perform all these functions under the condition of their normal, physiological concentration in the female body. An excess of these hormones causes both cosmetic defects and metabolic disorders, and a woman's fertility.

Types, causes, mechanism of development of hyperandrogenism

Depending on the origin, 3 forms of this pathology are distinguished:

ovarian (ovarian);
adrenal;
mixed.

If the root of the problem is in these organs (ovaries or adrenal cortex), hyperandrogenism is called primary. In the case of a pathology of the pituitary gland, which causes dysregulation of androgen synthesis, it is regarded as secondary. In addition, this condition can be inherited or develop during the life of a woman (that is, be acquired).

Depending on the level of male sex hormones in the blood, hyperandrogenism is distinguished:

absolute (their concentration exceeds normal values);
relative (the level of androgens is within the normal range, however, they are intensively metabolized into more active forms, or the sensitivity of target organs to them is significantly increased).

In most cases, the cause of hyperandrogenism is. It also occurs when:

adrenogenital syndrome;
neoplasms or ovaries;
and some other pathological conditions.

Hyperandrogenism can also develop as a result of a woman taking anabolic steroids, male sex hormone preparations, and cyclosporine.

Clinical manifestations

These women are worried increased prolapse hair on the head and their appearance in other places (on the face or chest).

Depending on the causative factor, the symptoms of hyperandrogenism vary from slight, mild hirsutism (increased hairiness) to pronounced viril syndrome(appearance of secondary male sexual characteristics in a sick woman).

Let us consider in more detail the main manifestations of this pathology.

Acne and seborrhea

- hair follicle disease sebaceous glands that occurs if their excretory ducts are clogged. One of the reasons (more correctly, even to say - the links of pathogenesis) of acne is precisely hyperandrogenism. It is physiological for the pubertal period, which is why rashes on the face are found in more than half of adolescents.

If acne persists in a young woman, it makes sense for her to be examined for hyperandrogenism, the cause of which in more than a third of cases will be polycystic ovary syndrome.

Acne can occur on its own or be accompanied (by increased production of sebum secretion selectively - in certain parts of the body). It can also occur under the influence of androgens.

hirsutism

This term denotes overgrowth hair in females in areas of the body dependent on androgens (in other words, a woman's hair grows in places typical of men - on the face, chest, between the shoulder blades, and so on). In addition, the hair changes its structure - from soft and light vellus to hard, dark (they are called terminal).

Alopecia

This term refers to baldness. Under the alopecia associated with an excess of androgens, they mean a change in the structure of the hair on the head from terminal (saturated with pigment, hard) to thin, light, short vellus and their subsequent loss. Baldness is found in the frontal, parietal and temporal areas heads. As a rule, this symptom indicates a prolonged high hyperandrogenism and is observed in most cases with neoplasms that produce male sex hormones.

Virilization (virile syndrome)

This term refers to the loss of the body's signs of a woman, the formation of male characteristics. Fortunately, this is a fairly rare condition - it is found in only 1 out of 100 patients suffering from hirsutism. The leading etiological factors are adrenoblastoma and ovarian tecomatosis. Less common cause given state become androgen-producing tumors of the adrenal glands.

Virilization is characterized by the following symptoms:

hirsutism;
acne
androgenetic alopecia;
a decrease in the timbre of the voice (baryphony; the voice becomes rough, like a man's);
reduction in the size of the sex glands;
an increase in the size of the clitoris;
muscle growth;
redistribution of subcutaneous adipose tissue according to the male type;
menstrual irregularities up to;
increased sex drive.

Diagnostic principles

An increase in the level of androgens in the patient's blood confirms the diagnosis.

In the diagnosis of hyperandrogenism, both complaints, anamnesis and data on the objective status of the patient, as well as laboratory and instrumental methods research. That is, after evaluating the symptoms and medical history data, it is necessary not only to identify the fact of an increase in the level of testosterone and other male sex hormones in the blood, but also to detect their source - a neoplasm, polycystic ovary syndrome or other pathology.

Sex hormones are examined on the 5th-7th day of the menstrual cycle. Determine blood levels total testosterone, SHBG, DHEA, follicle-stimulating hormone, luteinizing hormone, and 17-hydroxyprogesterone.

To find the source of the problem, an ultrasound of the pelvic organs is performed (if ovarian pathology is suspected, using a transvaginal sensor) or, if possible, magnetic resonance imaging of this area.

In order to diagnose a tumor of the adrenal glands, the patient is prescribed a computer or scintigraphy with radioactive iodine. It should be noted that small tumors (less than 1 cm in diameter) in many cases cannot be diagnosed.

If the results of the above studies are negative, the patient may be prescribed catheterization of the veins that carry blood away from the adrenal glands and ovaries in order to determine the level of androgens in the blood flowing directly from these organs.

Principles of treatment

The tactics of treating hyperandrogenism in women depends on the pathology due to which this condition arose.

In most cases, patients are prescribed combined oral contraceptives, which, in addition to contraception, also have an antiandrogenic effect.

Adrenogenital syndrome requires the appointment of glucocorticoids.

If the level of androgens in the blood of a woman is elevated due to hypothyroidism or advanced level prolactin, drug correction of these conditions comes to the fore, after which the concentration of male sex hormones decreases by itself.

With obesity and hyperinsulism, a woman is shown to normalize body weight (by following dietary recommendations and regular physical activity) and taking metformin.

Neoplasms of the adrenal glands or ovaries that produce androgens are removed surgically even in spite of their benign nature.

Which doctor to contact

With symptoms of hirsutism, you should contact a gynecologist-endocrinologist. Additional assistance will be provided by specialized specialists - a dermatologist, trichologist, nutritionist.

Conclusion

Hyperandrogenism in women is a complex of symptoms arising from an increased concentration of male sex hormones in the blood, which accompanies a series of endocrine diseases. The most common causes of it are polycystic ovary syndrome and adrenogenital syndrome.

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

Source: clinic-bioss.ru

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions.

Causes

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

increased levels of androgens in the blood serum;
conversion of androgens to metabolically 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 impaired ovarian function. 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, hypothalamus and adrenal glands. The incidence of PCOS among women of childbearing age reaches 5-10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

adrenogenital syndrome;
congenital adrenal hyperplasia;
galactorrhea-amenorrhea syndrome;
stromal tecomatosis and hyperthecosis;
virilizing tumors of the ovaries and adrenal glands, producing 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 body hair, 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. At high density androgen receptor cells of ovarian tissues, skin, hair follicles, sebaceous and sweat glands, symptoms of hyperandrogenism can be observed when 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 probability of manifestation of pathological conditions associated with the symptom complex of hyperandrogenism 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 drugs containing steroid hormones.

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

Kinds

IN gynecological practice There are several types of hyperandrogenic conditions that differ from each other in etiology, course and symptoms. Endocrine pathology can be both congenital and acquired. Primary hyperandrogenism, not associated with other diseases and functional disorders, due to violations of the pituitary regulation; the secondary is a consequence of concomitant pathologies.

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

ovarian, or ovarian;
adrenal, or adrenal;
mixed - simultaneously there are signs of ovarian and adrenal forms.

Relative hyperandrogenism occurs against the background of the normal content of male hormones with excessive sensitivity of target tissues to sex steroids or enhanced transformation of the latter into metabolically active forms. In a separate category, iatrogenic hyperandrogenic conditions are distinguished, which have developed as a result of prolonged use hormonal drugs.

Fast development 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 the standard set of symptoms:

disorders of menstrual function;
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 genesis, which is accompanied by anomalies in the development of follicles, hyperplasia and uneven exfoliation of the endometrium, cystic changes in the ovaries. Patients complain of poor and painful menstruation, irregular or anovulatory cycles, uterine bleeding and premenstrual syndrome. With galactorrhea-amenorrhea syndrome, progesterone deficiency is noted.

Severe metabolic disorders - dyslipoproteinemia, insulin resistance and hypothyroidism are characteristic of the primary pituitary and adrenal forms of hyperandrogenism. Approximately 40% of patients are found to have male-type abdominal obesity or 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 poorly expressed: in adult women, breast underdevelopment, a decrease in the timbre of the voice, an increase in muscle mass and body hair are noted; for girls, it is typical later than menarche. 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 activity of dihydrotestosterone. The effect of a hormone that stimulates secretory activity skin glands, changes the physico-chemical properties of sebum, causing blockage excretory ducts and inflammation of the sebaceous glands. As a result, 70-85% of patients with hyperandrogenism have signs of acne - acne, expansion of 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 excessive hair growth throughout the body, hirsutism is characterized by the transformation of vellus hair into coarse terminal hair in androgen-sensitive areas - above the upper lip, on the neck and chin, on the back and chest around the nipple, on the forearms, shins and inner side of the thigh. In postmenopausal women, bitemporal and parietal alopecia are occasionally noted - hair loss at the temples and in the crown area, respectively.

Source: woman-mag.ru

Features of the course of hyperandrogenism in children

In the prepubertal period, girls may show congenital forms hyperandrogenism due to genetic abnormalities or fetal exposure to androgens during pregnancy. Pituitary hyperandrogenism and congenital adrenal hyperplasia are recognized by the pronounced virilization of the girl and anomalies in the structure of the genitals. With adrenogenital syndrome, there may be signs of false hermaphroditism: clitoral hypertrophy, fusion of the labia majora and vaginal opening, displacement of the urethra to the clitoris, and urethrogenital sinus. At the same time, there are:

early overgrowth of fontanelles and epiphyseal fissures in infancy;
premature body hair;
rapid somatic growth;
delayed puberty;
Late menarche or no menses.

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

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

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

Diagnostics

It is possible to suspect hyperandrogenism in a woman by characteristic changes in appearance and on the basis of anamnesis data. To confirm the diagnosis, determine the form and identify the cause of the hyperandrogenic state, a blood test is performed for androgens - total, free and biologically available testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate (DEA sulfate), and sex hormone binding globulin (SHBG).

In hyperandrogenic conditions of adrenal, pituitary and transport etiology, a woman is referred for MRI or CT of the pituitary and adrenal glands. According to indications, blood tests for 17-hydroxyprogesterone and urine tests for cortisol and 17-ketosteroids are performed. For the diagnosis of metabolic pathologies, laboratory tests are used:

samples with dexamethasone and human chorionic gonadotropin;
determination of the level of cholesterol and lipoproteins;
blood tests for sugar and glycated glycogen, glucose tolerance test;
tests with adrenocorticotropic hormone.

To improve the visualization of the 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 a stable result only in the treatment of major diseases, such as PCOS or Itsenko-Cushing's syndrome, and concomitant pathologies - hypothyroidism, insulin resistance, hyperprolactinemia, etc.

Hyperandrogenic states of ovarian genesis are corrected with the help of estrogen-progestin oral contraceptives that suppress the secretion of ovarian hormones and block androgen receptors. With strong androgenic dermopathy, a peripheral blockade of skin receptors, sebaceous glands and hair follicles is performed.

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

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

Prevention

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

With a tendency to hyperandrogenism and congenital adrenopathy, it is important to adhere to a healthy lifestyle and a sparing regime of work and rest, to refuse bad habits, limit the impact of stress, have an orderly sex life, avoid abortions and emergency contraception; uncontrolled intake of hormonal drugs and anabolic drugs is strictly prohibited. Equally important is the control of body weight; moderate physical activity without strenuous exercise.

Most often, hyperandrogenism in women is first diagnosed in 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 current hyperandrogenism increases the risk of developing metabolic syndrome and type II diabetes mellitus, atherosclerosis, arterial hypertension and coronary heart disease. According to some reports, 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 in androgenic dermopathy has a strong psycho-traumatic effect on patients.

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

Video from YouTube on the topic of the article:

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 mineral density bone tissue. 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, to accurately determine the sex of a child, it is required ultrasound diagnostics and genetic analysis.

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

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, overgrowth 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. Secondly, women may experience hypersensitivity 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 such a pathology, an abnormal structure of the external genital organs is revealed. 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 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. IN clinical practice this syndrome is manifested by autonomic disorders and multiple dysfunction of the endocrine glands (including the adrenal glands and ovaries).

Diagnostics

If a girl or an adult woman has 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 is most often needed for stromal ovarian hyperplasia and hyperthecosis.