Hyperandrogenism in Women

Hyperandrogenism is the elevated level of male hormones in women, which can manifest as excess hair growth, acne, alopecia, hirsutism, and virilization.

Hirsutism is excessive terminal hair growth in a male-pattern distribution caused by androgen excess affecting hair follicles.

Virilization in women includes features such as temporal balding, deepening of the voice, enlargement of the clitoris, and loss of feminine body fat distribution.

<p>In women, androgens are primarily produced by the ovaries and adrenal glands.</p> Signup and view all the answers

<p>Luteinizing hormone (LH) stimulates the production of androgens in the ovaries.</p> Signup and view all the answers

<p>Sex hormone-binding globulin (SHBG) binds androgens in circulation, regulating their bioavailability by limiting the free fraction.</p> Signup and view all the answers

<p>Testosterone is converted to the more potent dihydrotestosterone (DHT) in target tissues via the enzyme 5α-reductase.</p> Signup and view all the answers

<p>Hyperandrogenic disorders can be divided into nonneoplastic and neoplastic disorders of the adrenal glands or ovaries.</p> Signup and view all the answers

<p>The primary method is ovarian suppression through the administration of an estrogen-progestin contraceptive.</p> Signup and view all the answers

<p>Estrogen stimulates SHBG production, which decreases free testosterone levels.</p> Signup and view all the answers

<p>Spironolactone acts as a peripheral antiandrogen by competing for testosterone-binding sites and decreasing testosterone production.</p> Signup and view all the answers

<p>Combining them prevents conception and protects against the antiandrogen blocking normal sexual differentiation in a male fetus.</p> Signup and view all the answers

<p>Other antiandrogens include flutamide and cyproterone acetate.</p> Signup and view all the answers

<p>Cosmetic improvement may take up to 6 months to begin and maximum effect may not be seen for up to 2 years.</p> Signup and view all the answers

<p>Eflornithine hydrochloride cream irreversibly inhibits epidermal androgenic activity to treat facial hirsutism.</p> Signup and view all the answers

<p>Complementary methods include shaving, depilatory creams, electrolysis, and laser therapy.</p> Signup and view all the answers

<p>Cystic teratomas, Brenner tumors, serous cystadenomas, and Krukenberg tumors can produce androgens indirectly.</p> Signup and view all the answers

<p>Idiopathic hirsutism is a condition where women have mild to moderate hirsutism with normal ovarian function and androgen levels, potentially caused by increased conversion of testosterone to DHT.</p> Signup and view all the answers

<p>Hirsutism in PCOS or late-onset CAH typically begins during puberty and progresses gradually into adulthood.</p> Signup and view all the answers

<p>Rapid hair growth may indicate the presence of a neoplasm of the ovary or adrenal gland.</p> Signup and view all the answers

<p>The presence of hirsutism and oligomenorrhea typically indicates polycystic ovary syndrome (PCOS).</p> Signup and view all the answers

<p>Physical examination findings include evaluating hirsutism severity using the Ferriman-Gallwey scoring system and checking for acne or alopecia.</p> Signup and view all the answers

<p>Acanthosis nigricans is a common physical marker associated with insulin resistance and hyperinsulinemia.</p> Signup and view all the answers

<p>In patients with PCOS, circulating total and free testosterone and DHEA-S levels are elevated in 50-75% of cases.</p> Signup and view all the answers

<p>21-hydroxylase deficiency is the primary enzyme deficiency that causes CAH.</p> Signup and view all the answers

<p>21-hydroxylase deficiency causes an accumulation of 17-hydroxyprogesterone, leading to elevated serum levels.</p> Signup and view all the answers

<p>Classic CAH presents symptoms at birth, while nonclassic CAH manifests later in life, typically during puberty.</p> Signup and view all the answers

<p>Ashkenazi Jews, Hispanics, and Slavs have a higher prevalence of nonclassic CAH.</p> Signup and view all the answers

<p>Hirsutism in CAH is caused by elevated levels of androgens such as testosterone due to enzyme deficiencies.</p> Signup and view all the answers

<p>Testosterone can be converted to dihydrotestosterone (DHT), which contributes to conditions like hirsutism and acne.</p> Signup and view all the answers

<p>A serum 17-hydroxyprogesterone level less than 2 ng/mL rules out nonclassic CAH.</p> Signup and view all the answers

<p>Cushing syndrome is defined as persistent hypercortisolism and can lead to excessive androgen production.</p> Signup and view all the answers

<p>DHEA-S levels above 7000 ng/mL.</p> Signup and view all the answers

<p>Virilization, which occurs in 98% of such tumors.</p> Signup and view all the answers

<p>It helps exclude late-onset CAH due to 21-hydroxylase deficiency.</p> Signup and view all the answers

<p>A 24-hour measurement for free urinary cortisol or an overnight dexamethasone suppression test.</p> Signup and view all the answers

<p>Significant ovarian pathology.</p> Signup and view all the answers

<p>Surgical removal of the tumor.</p> Signup and view all the answers

<p>Unilateral salpingo-oophorectomy.</p> Signup and view all the answers

<p>Assessment tailored for patients with BMI &gt;30 kg/m2 or those with significant risk factors for diabetes.</p> Signup and view all the answers