Ovarian hyperandrogenism is the norm in women and the pituitary gland. Hyperandrogenism in women: symptoms and treatment. Symptomatic therapy of comorbidities

Hyperandrogenism is an endocrine disease caused by increased secretion of male sex hormones in a woman's body. Androgens are produced by the ovaries and the adrenal cortex. Depending on the primary cause of the pathology, clinical symptoms may differ.

Hyperandrogenism in women causes increased secretion of luteinizing hormone in the pituitary gland, which blocks the release of follicle-stimulating hormone and estradiol. As a result, the process of follicle maturation is disrupted, the release of the egg does not occur (anovulation). High androgen levels contribute to the formation of multiple cysts in the ovaries (polycystic ovary syndrome).

Male hormones reduce the susceptibility of peripheral tissues to insulin, which leads to an increase in blood glucose levels, impaired glucose tolerance, carbohydrate metabolism and the development of type 2 diabetes mellitus.

Classify true and idiopathic hyperandrogenism. In the first case, the level of androgens in the woman's blood is increased, and in the second, the sensitivity of peripheral tissue receptors to male hormones is increased.

Causes of pathology

What is hyperandrogenism and why does it occur? The main causes of the disease are:

tumors, metastases of the adrenal glands;
violation of the hypothalamic-pituitary regulation caused by trauma, tumors, inflammatory diseases of the brain;
ovarian tumors: luteoma, tekoma;
androgenital syndrome is a congenital abnormality of the adrenal cortex, in which there is an increased production of testosterone.

In women, the causes of hyperandrogenism cause a violation of the hormonal balance, the functioning of the reproductive system, metabolic processes in the body.

Symptoms of ovarian hyperandrogenism

The disease is of ovarian and adrenal genesis - depending on the organ, which begins to intensively produce androgens. Ovarian hyperandrogenism in most cases develops against the background of polycystic ovary syndrome, less often hormone-producing tumors cause pathology.

PCOS is characterized by menstrual irregularities, infertility, and increased levels of androgens in the blood. The girl's figure changes according to the masculine type, hair on the face and body begins to grow, the volume of the waist and chest increases, the fatty layer is deposited in the lower abdomen. The work of the sebaceous glands is disrupted, seborrhea appears, acne, which does not respond to treatment. Stretch marks appear on the skin of the thighs, buttocks. Sleep apnea (holding your breath) leads to insomnia.

The photo shows a woman with characteristic signs of hirsutism.

The characteristic symptoms of hyperandrogenism in PCOS are the appearance of premenstrual syndrome. Women become irritable, their mood often changes, migraine worries, intense pains in the lower abdomen, swelling, soreness of the mammary glands.

The ovaries increase in size 2-3 times, their capsule thickens. Multiple cystic formations are found inside the organ. Hormonal imbalance causes thickening and hyperplasia of the endometrium of the uterus, menstruation becomes longer, more abundant, with the release of blood clots.

Symptoms of adrenal hyperandrogenism

This type of virilization develops against the background of androgenital syndrome. It is an inherited disorder that causes an increased secretion of androgens in the adrenal cortex. A congenital deficiency of organ enzymes up to a certain point is compensated by the body, but under the influence of a number of factors, hormonal imbalance occurs. Pregnancy, severe stress, and the onset of sexual activity can provoke this condition.

The cause of adrenal hyperandrogenism can be hormone-producing tumors, Itsenko-Cushing's disease, hyperprolactinemia, acromegaly. Cancer cells in the reticular cortex produce "weak" androgens. In the process of metabolism, male hormones turn into a more active form and change the general hormonal background of a woman. Obesity helps speed up these processes.

Adrenal hyperandrogenism causes cyclic disturbances in the ovaries due to an increase in estrogen levels, the growth and maturation of the follicle is suppressed, the menstrual cycle is disrupted, and menstruation may stop altogether. The process of ovulation does not occur, a woman cannot become pregnant and bear a child.

Symptoms of adrenal hyperandrogenism in girls:

deformation of the external genitalia at birth, it is difficult to determine the gender of a child (female hermaphroditism);
delayed sexual development, menarche begins at the age of 15-16, the menstrual cycle is irregular, accompanied by profuse blood loss;
in adolescent girls, signs of hirsutism are observed: hair grows on the face and body like in men;
acne, seborrhea, skin pigmentation;
partial atrophy of the mammary glands;
an increase in the size of the clitoris;
alopecia - hair loss on the head;
the figure changes: narrow hips, broad shoulders, short stature;
rough voice.

In women of reproductive age, adrenal hyperandrogenism leads to early termination of pregnancy. This is caused by the cessation of growth of the uterus due to the formation of a defective corpus luteum. Most girls have completely disrupted menstrual and childbearing function, infertility develops, and sexual desire increases. Hirsutism is poorly expressed, the physique does not change, metabolic processes are not disturbed.

Mixed type of hyperandrogenism

Hyperandrogenism of mixed genesis is manifested by symptoms of the ovarian and adrenal forms of the disease. Women have polycystic ovary disease and signs of androgenital syndrome.

Manifestations of a mixed type of disease:

acne;
striae;
high blood pressure;
violation of the menstrual cycle, amenorrhea;
cysts in the ovaries;
infertility, early termination of pregnancy;
impaired glucose tolerance or high blood sugar;
increased content of low density lipoproteins.

Hyperandrogenism can be caused by systemic diseases that affect the adrenal cortex, ovaries or brain, and disrupt metabolism. These are pituitary adenomas, anorexia nervosa, schizophrenia, type 2 diabetes mellitus, acromegaly, prolactinoma.

Peripheral and central hyperandroegnia

With damage to the central nervous system, inflammatory, infectious diseases or intoxication of the body, the secretion of gonadotropic hormones of the pituitary gland, which are responsible for the production of luteinizing and follicle-stimulating hormone, can be suppressed. As a result, the process of maturation of the follicle in the ovary and the synthesis of sex hormones are disrupted, and the production of androgens is increased.

In women, symptoms of polycystic disease, ovarian dysfunction, menstrual disorders, skin rashes, PMS are found.

Peripheral hyperandrogenism is caused by an increase in the activity of the skin enzyme, the sebaceous glands 5-α-reductase, which converts testosterone into the more active androgen dihydrotestosterone. This leads to hirsutism of varying severity, the appearance of vulgar acne.

Hyperandrogenism during pregnancy

In pregnant women, an increase in androgen levels is the cause of spontaneous abortion. The most dangerous periods are the first 7-8 and 28-30 weeks. In 40% of patients, intrauterine fetal hypoxia is observed, most often in the third trimester. Another complication is late toxicosis, while kidney function worsens, blood pressure rises, and body edema appears.

Hyperandrogenism during pregnancy can lead to premature discharge of amniotic fluid, complicated labor. Changes in the hormonal background negatively affect the development of the child, cerebral circulation may be impaired in infants, there are signs of intrauterine malnutrition.

Hyperandrogenism and pregnancy are reasons for urgent hormone therapy to prevent abortion and other complications. Women who have previously had miscarriages, miscarriage, increased levels of male hormones, it is necessary to conduct a thorough examination at the stage of planning pregnancy.

Diagnosis of the disease

Diagnosis - hyperandrogenism is established according to the results of laboratory tests on the level of hormones. With polycystic ovary syndrome in a woman's blood, the level of testosterone, androstenedione, and luteinizing hormone rises. The concentration of FSH, prolactin, DHEA in the blood and 17-CS in the urine remains within normal limits. The LH / FSH ratio increased 3-4 times. With hormone-dependent ovarian tumors, testosterone and prolactin levels are significantly increased in the blood.

The mixed form of the disease is characterized by a slight increase in the level of testosterone, LH, DHEA-S in the blood and 17-KS in the urine. The concentration of prolactin is normal, and estradiol and FSH are reduced. The LH / FSH ratio is 3.2.

To determine the primary cause of hyperandrogenism, tests are performed with Dexamethasone and chorionic gonadotropin. A positive HCG test result confirms polycystic ovarian disease, which is causing hormonal imbalances. A negative answer indicates the adrenal nature of hyperandrogenism.

Abraham's test allows you to identify a disease of adrenal genesis, with the introduction of synthetic glucocorticoids, the synthesis of ACTH in the anterior pituitary gland is suppressed, which stops stimulation of the adrenal cortex. If the result is positive, it is adrenal hyperandrogenism, a negative response may be a sign of a cortical tumor.

Additionally, an ultrasound scan of the ovaries is performed to identify cysts, changes in the size and structure of the organ. Electroencephalography, MRI, CT of the brain are indicated if the pituitary gland is suspected.

Treatment methods

The therapy is prescribed individually for each patient. Androgen receptor blockers reduce the effect of male hormones on the skin, ovaries (Flutamide, Spironolactone). Androgen secretion inhibitors inhibit the production of testosterone by the endocrine glands (Cyproterone acetate). These funds restore the balance of hormones, eliminate the symptoms of pathology.

Adrenal hyperandrogenism is compensated by glucocorticoids, which suppress excess androgens. Women are prescribed Dexamethasone, Prednisolone, and they are taken during pregnancy if the expectant mother has an increased testosterone level. It is especially important to timely treat girls who have close relatives with congenital androgenital syndrome. The dosage and duration of the medication is prescribed by the doctor.

Hormonal treatment of hyperandrogenism is carried out with glucocorticosteroids, combined oral contraceptives (Diane-35), GnRH agonists. These drugs are used to treat mild ovarian hyperandrogenism, PCOS.

Drug-free treatment

To restore hormonal balance, women are advised to regularly engage in moderate physical activity, give up bad habits, and lead a healthy lifestyle. It is important to adhere to a diet, make a balanced diet that excludes coffee, alcohol, carbohydrates, animal fats. It is useful to eat fresh fruits, vegetables, dairy products, diet meats and fish. To replenish the deficiency of vitamins, pharmaceutical preparations are taken.

Treatment with folk remedies can only be carried out in combination with the main therapy. You should first consult a doctor.

Hyperandrogenism causes disturbances in the work of many organs and systems, leads to the development of adrenal and ovarian insufficiency, infertility, type 2 diabetes mellitus. To prevent the onset of symptoms of hirsutism, skin rashes, metabolic syndrome, hormone therapy is indicated.

Bibliography

Kozlova V.I., Puchner A.F. Viral, chlamydial and mycoplasma diseases of the genitals. A guide for doctors. St. Petersburg 2000.-574 p.
Miscarriage, infection, innate immunity; Makarov O.V., Bakhareva I.V. (Gankovskaya L.V., Gankovskaya O.A., Kovalchuk L.V.) - "GEOTAR - Media." - Moscow. - 73 p. - 2007.
Emergencies in obstetrics and gynecology: diagnosis and treatment. Pearlman M., Tintinally J. 2008 Publisher: Binom. Knowledge laboratory.
L.V. Adamyan and other Malformations of the uterus and vagina. - M .: Medicine, 1998.

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

Source: klinika-bioss.ru

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

Causes

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

increased serum androgen levels;
conversion of androgens into 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 dysfunction of the ovaries. The most common occurrence is polycystic ovary syndrome (PCOS) - the formation of multiple small cysts against the background of a complex of endocrine disorders, including pathologies of the thyroid and pancreas, pituitary gland, hypothalamus and adrenal glands. The incidence of PCOS among women of fertile age reaches 5-10%.

Androgen hypersecretion is also observed with the following endocrinopathies:

adrenogenital syndrome;
congenital adrenal hyperplasia;
galactorrhea-amenorrhea syndrome;
stromal tekomatosis 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, there is a transformation of testosterone produced by the ovaries into dihydrotestosterone (DHT), a steroid hormone that stimulates the production of sebum and the growth of stem hair on the body, and in rare cases, loss of scalp hair.

Compensatory insulin overproduction stimulates the production of androgen-producing ovarian cells. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing's syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptors in ovarian tissue cells, skin, hair follicles, sebaceous and sweat glands, symptoms of hyperandrogenism can be observed with a normal level of 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 of the ovaries and appendages;
miscarriages and abortions, especially in early youth;
metabolic disorders;
overweight;
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.

Views

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

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

ovarian, or ovarian;
adrenal, or adrenal;
mixed - signs of ovarian and adrenal forms are present at the same time.

Relative hyperandrogenism occurs against the background of a normal content of male hormones with excessive sensitivity of target tissues to sex steroids or enhanced transformation of the latter into metabolically active forms. Iatrogenic hyperandrogenic states that develop as a result of prolonged use of hormonal drugs are distinguished into a separate category.

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

Symptoms of hyperandrogenism

The clinical picture of hyperandrogenic states is characterized by a wide variety of manifestations that fit into the standard complex 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 ovarian hyperandrogenism, which is accompanied by anomalies in the development of follicles, hyperplasia and uneven detachment of the endometrium, cystic changes in the ovaries. Patients complain of scanty 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. In about 40% of cases, patients have abdominal obesity of the male type or with a uniform distribution of 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, there is underdevelopment of the chest, a decrease in the timbre of the voice, an increase in muscle mass and body hair; later menarche is typical for girls. 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 DHT activity. The effect of the hormone, which stimulates the secretory activity of the skin glands, changes the physicochemical properties of sebum, provoking blockage of the excretory ducts and inflammation of the sebaceous glands. As a result, 70–85% of patients with hyperandrogenism show signs of acne - acne, enlarged skin pores and comedones.

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

Less common are other manifestations of androgenic dermatopathy - seborrhea and hirsutism. Unlike hypertrichosis, in which there is excessive hair growth throughout the body, hirsutism is characterized by the transformation of vellus hair into hard 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, legs and inner side of the thigh. In postmenopausal women, bitemporal and parietal alopecia is occasionally noted - hair loss on the temples and in the crown of the head, respectively.

Source: woman-mag.ru

Features of the course of hyperandrogenism in children

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

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

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 adrenal hyperplasia and a severe course of adrenogenital syndrome, the development of an adrenal crisis is possible - acute adrenal insufficiency, associated with a threat to life. Parents should be alerted to a sharp drop in blood pressure to a critical level, 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 ovary disease. The onset of PCOS often occurs at the stage of the formation of menstrual function.

Congenital adrenal hyperandrogenism in children and adolescent girls can be suddenly 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 shape 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), as well as sex hormone binding globulin (SHBG).

In hyperandrogenic states 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. Laboratory tests are used to diagnose metabolic pathologies:

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

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

Treatment of hyperandrogenism

Correction of hyperandrogenism gives a lasting 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 conditions of ovarian origin are corrected with the help of estrogen-progestational oral contraceptives, which suppress the secretion of ovarian hormones and block androgen receptors. With severe androgenic dermopathy, 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 metabolic syndrome, insulin synthetizers are additionally prescribed in combination with a 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 is a prerequisite for the restoration of reproductive function.

Prophylaxis

To prevent hyperandrogenic conditions, women and adolescent girls are recommended preventive examinations by a gynecologist and screening tests to control androgenic status. Early detection and treatment of 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 adrenopathies, it is important to adhere to a healthy lifestyle and a sparing regime of work and rest, give up bad habits, limit the effects of stress, lead an orderly sex life, avoid abortion and emergency contraception; uncontrolled intake of hormonal drugs and anabolic drugs is strictly prohibited. Control of body weight is also important; moderate physical activity without heavy physical exertion is preferable.

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

Consequences and complications

Hyperandrogenic conditions are one of the most common causes of female infertility and miscarriage. A prolonged course of 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 some 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 be suddenly complicated by an adrenal crisis. Due to the possibility of death at the first signs of acute adrenal insufficiency, the child should be immediately taken to the hospital.

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- a group of endocrinopathies characterized by excessive secretion or high activity of male sex hormones in the female body. Manifestations of various syndromes, similar in symptomatology, but different in pathogenesis, are disorders of metabolic, menstrual and reproductive functions, androgenic dermopathy (seborrhea, acne, hirsutism, alopecia). The diagnosis of hyperandrogenism in women is based on examination data, hormonal screening, ultrasound of the ovaries, CT of the adrenal glands and pituitary gland. Correction of hyperandrogenism in women is carried out using COCs or corticosteroids, tumors are removed promptly.

General information

Hyperandrogenism in women is a concept that combines pathogenetically heterogeneous syndromes caused by increased production of androgens by the endocrine system or excessive susceptibility of target tissues to them. The importance of hyperandrogenism in the structure of gynecological pathology is explained by its wide distribution among women of childbearing age (4–7.5% in adolescent girls, 10–20% in patients over 25 years old).

Androgens - male sex hormones of the steroid group (testosterone, ASD, DHEA-S, DHT) are synthesized in a woman's body by the ovaries and adrenal cortex, less - by subcutaneous adipose tissue under the control of pituitary hormones (ACTH and LH). Androgens act as precursors of glucocorticoids, female sex hormones - estrogens and form libido. In puberty, androgens are the most significant in the process of growth leap, maturation of tubular bones, closure of the diaphyseal-epiphyseal cartilaginous zones, and the appearance of female hair growth. However, an excess of androgens in the female body causes a cascade of pathological processes that disrupt general and reproductive health.

Hyperandrogenism in women not only causes cosmetic defects (seborrhea, acne, alopecia, hirsutism, virilization), but also becomes the cause of metabolic disorders (metabolism of fats and carbohydrates), menstrual and reproductive function (folliculogenesis abnormalities, polycystic ovarian degeneration, progesterone deficiency oligomenorrhea, anovulation, miscarriage, infertility in women). Prolonged hyperandrogenism in combination with dysmetabolism increases the risk of developing endometrial hyperplasia and cervical cancer, type II diabetes mellitus and cardiovascular disease in women.

Causes of hyperandrogenism in women

The development of the transport form of hyperandrogenism in women is noted against the background of insufficient globulin that binds sex steroids (SHBG), which blocks the activity of the free fraction of testosterone (with Itsenko-Cushing's syndrome, hypothyroidism, dyslipoproteinemia). Compensatory hyperinsulism in pathological insulin resistance of target cells enhances the activation of androgen-secreting cells of the ovarian-adrenal complex.

In 70–85% of women with acne, hyperandrogenism is observed at normal levels of androgens in the blood and increased sensitivity of the sebaceous glands to them due to an increase in the density of hormonal receptors in the skin. The main regulator of proliferation and lipogenesis in the sebaceous glands - dihydrotestosterone (DHT) - stimulates hypersecretion and changes in the physicochemical properties of sebum, leading to the closure of the excretory ducts of the sebaceous glands, the formation of comedones, the appearance of acne and acne.

Hirsutism is associated with hypersecretion of androgens in 40-80% of cases, in the rest - with increased conversion of testosterone into more active DHT, which provokes excessive growth of stem hair in androgen-sensitive areas of the female body or hair loss on the head. In addition, women may experience iatrogenic hyperandrogenism due to the intake of drugs with androgenic activity.

Symptoms of hyperandrogenism in women

The clinic of hyperandrogenism in women depends on the severity of the disorders. With hyperandrogenism of non-neoplastic genesis, for example, with PCOS, clinical signs slowly progress over several years. The initial symptoms manifest during puberty, clinically manifesting themselves as oily seborrhea, acne vulgaris, menstrual irregularities (irregularity, alternation of delays and oligomenorrhea, in severe cases - amenorrhea), excessive hair on the face, arms, legs. Subsequently, cystic transformation of the ovarian structure develops, anovulation, progesterone deficiency, relative hyperestrogenemia, endometrial hyperplasia, decreased fertility and infertility. In postmenopausal women, hair loss occurs first in the temporal regions (bitemporal alopecia), then in the parietal region (parietal alopecia). Severe androgenic dermatopathy in many women leads to the development of neurotic and depressive conditions.

Hyperandrogenism in AHS is characterized by virilization of the genitals (female pseudohermaphroditism), masculinization, late menarche, breast underdevelopment, coarsening of the voice, hirsutism, acne. Severe hyperandrogenism with dysfunction of the pituitary gland is accompanied by a high degree of virilization, massive obesity of the android type. The high activity of androgens contributes to the development of metabolic syndrome (hyperlipoproteinemia, insulin resistance, type II diabetes), arterial hypertension, atherosclerosis, ischemic heart disease. With androgen-secreting adrenal and ovarian tumors, symptoms develop rapidly and progress rapidly.

Diagnosis of hyperandrogenism in women

In order to diagnose pathology, a thorough history and physical examination are carried out with an assessment of sexual development, the nature of menstrual irregularities and hair growth, signs of dermopathy; total and free testosterone, DHT, DEA-S, SHBG in blood serum are determined. Revealing an excess of androgens requires clarification of its nature - adrenal or ovarian.

An increased level of DHEA-S serves as a marker of adrenal hyperandrogenism, and an increase in the amount of testosterone and ASD for ovarian hyperandrogenism. With a very high level of DHEA-S> 800 μg / dl or total testosterone> 200 ng / dl, women are suspected of an androgen-synthesizing tumor, which requires CT or MRI of the adrenal glands, ultrasound of the pelvic organs, if the imaging of the neoplasm is difficult, selective catheterization of the adrenal and ovarian veins. Ultrasound diagnostics also allows you to establish the presence of polycystic ovarian deformity.

With ovarian hyperandrogenism, the hormonal levels of a woman are assessed: levels of prolactin, LH, FSH, estradiol in the blood; with adrenal - 17-OPG in the blood, 17-KS and cortisol in the urine. It is possible to carry out functional tests with ACTH, tests with dexamethasone and hCG, CT of the pituitary gland. It is mandatory to study carbohydrate and fat metabolism (levels of glucose, insulin, HbA1C, total cholesterol and its fractions, glucose tolerance test). Women with hyperandrogenism are shown consultations of an endocrinologist, dermatologist, genetics.

Treatment of hyperandrogenism in women

Treatment of hyperandrogenism is long-term, requiring a differentiated approach to patient management tactics. The main means of correcting hyperandrogenic conditions in women are estrogen-progestational oral contraceptives with an antiandrogenic effect. They provide inhibition of the production of gonadotropins and the ovulation process, suppression of the secretion of ovarian hormones, including testosterone, an increase in the level of SHBG, and blocking of androgen receptors. Hyperandrogenism with AHS is stopped with corticosteroids, they are also used to prepare a woman for pregnancy and during gestation with this type of pathology. In the case of high hyperandrogenism, the courses of antiandrogenic drugs in women are extended to a year or more.

In androgen-dependent dermatopathy, peripheral androgen receptor blockade is clinically effective. At the same time, pathogenetic treatment of subclinical hypothyroidism, hyperprolactinemia and other disorders is carried out. For the treatment of women with hyperinsulism and obesity, insulin sensitizers (metformin), weight loss measures (hypocaloric diet, physical activity) are used. Against the background of the treatment, the dynamics of laboratory and clinical parameters is monitored.

Androgen-secreting tumors of the ovaries and adrenal glands are usually benign in nature, but if they are detected, surgical removal is necessary. Relapses are unlikely. With hyperandrogenism, dispensary observation and medical support of a woman are shown for the successful planning of pregnancy in the future.

Hyperandrogenism is a pathology in which the hormonal background of a woman undergoes significant changes. Too much of the hormone androgen, which is considered male, is produced. In a woman's body, this hormone performs many necessary functions, but its excessive amount leads to unpleasant consequences, the treatment of which is necessary.

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 for mature women because they synthesize estrogen, maintain a sufficient level of libido and strengthen bone tissue.

What it is?

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.

Causes of occurrence

The following main causes of this syndrome can be distinguished:

the presence of adrenal tumors;
improper production of a special enzyme that synthesizes androgens, as a result of which their excessive accumulation in the body occurs;
pathology of the thyroid gland (hypothyroidism), pituitary tumors;
diseases and malfunctions of the ovaries, provoking excessive production of androgens;
childhood obesity;
long-term use of steroids during professional strength sports;
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, the development of pathology is possible in childhood.

Congenital hyperandrogenism sometimes does not allow us to accurately determine the sex of the child born. A girl may have large labia, an enlarged clitoris to the size of a penis. The appearance of the internal genital organs is normal.

One of the varieties of adrenogenital syndrome is the salt-wasting form. The disease is hereditary and is usually detected in the first months of a child's life. As a result of unsatisfactory 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.

Classification

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

absolute (their concentration exceeds normal values);
relative (the level of androgens is within normal limits, 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 polycystic ovary syndrome. It also takes place when:

adrenogenital syndrome;
galactorrhea-amenorrhea syndrome;
neoplasms of the adrenal glands or ovaries;
hypofunction of the thyroid gland;
Itsenko-Cushing's syndrome and some other pathological conditions.
a woman taking anabolic steroids, male sex hormone drugs and cyclosporine.

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

ovarian (ovarian);
adrenal;
mixed.

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

Symptoms of hyperandrogenism

Among all the symptoms of hyperandrogenism in women, the following predominate:

Hirsutism - excess hair growth in women, the so-called male-pattern hair growth, is the most common sign of hyperandrogenism. It can be talked about when hair appears on the abdomen along the midline, on the face, and on the chest. At the same time, bald patches are possible on the head.
This symptom should be distinguished from hypertrichosis - excess hair growth, independent of androgens, which can be either congenital or acquired (with various diseases, for example, with porphyrias). It is also necessary to pay attention to the racial identity of the patient - so in Eskimos and women from Central Asian countries, hair growth is more pronounced than in women in Europe or North America.
Rash on the face, acne, signs of flaking. Often such defects on the face occur during adolescence against the background of hormonal changes in the body. With hyperandrogenism in women, cosmetic defects on the face last much longer, and neither lotions nor creams can save you from this problem.
Opsooligomenorrhea (shortened and separated by a long period of time), amenorrhea (absence of menstruation) and infertility - most often this symptom occurs in polycystic ovaries, accompanied by hyperandrogenism.
Overweight. Overweight in women becomes a common cause of hormonal disruption, in which the menstrual cycle is disrupted.
Atrophy of the muscles of the extremities, abdominal muscles, osteoparosis, skin atrophy are most characteristic of Cushing's syndrome (or Itsenko-Cushing in Russian literature).
Increased risk of infection. As a result of hormonal disruption, the functioning of many organs and systems is disrupted, which has a destructive effect on immunity, increasing the risk of getting and developing infections.
Violation of glucose tolerance - mainly with damage to the adrenal glands, often also with pathology from the ovaries.
The formation of the external genital organs of an intermediate type (hypertrophy of the clitoris, urogenital sinus, partial fusion of the labia majora) - is detected immediately after birth or in early childhood; more often with congenital adrenal hyperplasia.
Arterial hypertension, myocardial hypertrophy, retinopathy (non-inflammatory damage to the retina).
Depression, drowsiness, increased fatigue - is associated, among other things, with the fact that the secretion of adrenal glucocorticoids is impaired.

Hyperandrogenism syndrome can be associated with certain medical conditions. So, among the reasons for the increased level of androgens are:

Hyperandrogenism syndrome may be associated with Cushing's syndrome. The reason for the development of this pathology lies in the adrenal glands as a result of excessive production of glucocorticoids. Among the symptoms of this disease are: a rounded face, an enlarged neck, fat deposition in the abdomen. Disruptions of the menstrual cycle, infertility, emotional disorders, diabetes mellitus, osteoporosis can be observed.
Stein-Leventhal syndrome. With this syndrome, cysts form in the ovaries, but not those that require immediate surgery, but temporary ones. A characteristic phenomenon for polycystic ovary syndrome is an enlargement of the ovary before menstruation and its decrease after menstruation has passed. With this syndrome, there is a lack of ovulation, infertility, increased hair growth, and overweight. There is a violation of insulin production, as a result of which patients may develop diabetes mellitus.
Age-related ovarian hyperplasia. It is observed at a fairly mature age in women as a result of an imbalance between estradiol and estrone. It manifests itself in the form of hypertension, diabetes mellitus, overweight, uterine oncology.

With hyperandrogenism, it is almost impossible to get pregnant due to the lack of ovulation. But nevertheless, sometimes a woman manages to conceive a child, but, unfortunately, it becomes impossible to bear him. A woman, against the background of hyperandrogenism, has a miscarriage or the fetus freezes in the womb.

Hyperandrogenism in pregnant women

Hyperandrogenism during pregnancy is becoming one of the most common causes of spontaneous abortion, which most often occurs in the early stages. If this disease is detected after the conception and bearing of the child, it is rather difficult to determine when it exactly arose. In this case, doctors are not very interested in the reasons for the development of hyperandrogenism, since all measures must be taken to preserve the pregnancy.

The signs of pathology in women in the position are no different from the symptoms that are observed at any other time. Miscarriage in most cases is due to the fact that the ovum is not able to attach well to the wall of the uterus due to hormonal imbalance in the body. As a result, even with a slight negative external influence, a miscarriage occurs. It is almost always accompanied by bloody vaginal discharge, pulling pains in the lower abdomen. Also, such a pregnancy is characterized by less severe toxicosis, which is present in most women in the first trimester.

Complications

The spectrum of possible complications for all the diseases described above is extremely large. Only some of the most important ones can be noted:

Metastasis of malignant tumors is a complication more characteristic of adrenal tumors.
With congenital pathology, developmental anomalies are possible, the most common of which are developmental anomalies of the genital organs.
Complications from other organ systems that are negatively influenced by changes in hormonal levels in the pathology of the adrenal glands, pituitary gland and ovaries: chronic renal failure, thyroid pathology, etc.

The list is far from complete with this simple listing, which speaks in favor of a timely visit to a doctor in order to anticipate their onset. Only timely diagnosis and qualified treatment can help achieve positive results.

Hirsutism

Diagnostics

Diagnosis of hyperandrogenism in women in a clinical laboratory:

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

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

Treatment of hyperandrogenism

The choice of treatment for hyperandrogenism largely depends on the underlying disease, which was the cause of the development of this pathological condition, as well as on the severity of the course of the disease and the severity of laboratory signs of hyperandrogenism.

In this regard, the management of patients and the determination of treatment tactics should be predominantly individual, taking into account all the characteristics of each particular patient. In many situations, the treatment of hyperandrogenism involves a whole range of therapeutic measures, both conservative and surgical.

normalization of body weight;
exercise regularly (walking, jogging, aerobics, and swimming work well);
a special hypocaloric diet (the amount of calories spent should be greater than the acquired ones).

Drug therapy:

agonists of gonadotropin-releasing hormone (decrease in the production of androgens and estrogens by the ovaries);
estrogen-progestin drugs (stimulation of the formation of female hormones);
antiandrogens (suppression of excess secretion of androgens by both the adrenal glands and the ovaries);
drugs high in ovarian hormone (progesterone).

Treatment of concomitant pathologies:

diseases of the thyroid gland and liver;
PCOS (polycystic ovary syndrome), when excess production of male sex hormones is accompanied by a lack of ovulation;
AGS (adrenogenital syndrome).

Surgical intervention:

removal of hormone-producing tumors.

Cosmetological types of correction:

discoloration of unwanted hair;
at home - plucking and shaving;
in a beauty salon - depilation, electrolysis, hair removal with wax or laser.

Polycystic ovary syndrome, which is the most common cause of ovarian hyperandrogenism, in many cases responds well to conservative treatment with a range of hormonal drugs.

With Cushing's syndrome with signs of hyperandrogenism in patients suffering from adrenal oncological pathologies, the only effective method of treatment is surgical.

Treatment of congenital adrenal hyperplasia should be started even at the stage of intrauterine development of the child, since this pathology leads to the development of a severe degree of hyperandrogenism.

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

Treatment of women suffering from hyperandrogenism in the postmenopausal period consists in the appointment of Klymen according to the generally accepted scheme, which has a pronounced antiandrogenic effect.

Prevention measures

Prevention is as follows:

regular (2-3 times a year) visits to the gynecologist;
minimization of increased loads (both psycho-emotional and physical);
giving up bad habits (smoking, alcohol abuse);
balanced and rational nutrition: give preference to foods rich in fiber, and give up fried and spicy foods, as well as preservation;
timely treatment of diseases of the liver, thyroid and adrenal glands.

Is it possible to conceive and bear a healthy child with such a diagnosis? Yes, it is quite. But given the increased risk of miscarriage, this is not easy to do. If you find out about the problem at the stage of planning pregnancy, you should first normalize hormonal levels. In the event that the diagnosis has already been made "in fact", the tactics of further therapy (which, we note, is not always necessary) will be determined by the attending physician, and you will only have to unconditionally follow all his recommendations.

Hyperandrogenism is a condition associated with excessive secretion of androgens and / or their increased effect on the body, which in women is most often manifested by virilization (the appearance of masculine features), in men, gynecomastia (enlargement of the mammary glands) and impotence.

Androgens is the name of a group of steroid hormones produced primarily by the testes in men and the ovaries in women, as well as by the adrenal cortex. Androgens include, for example: testosterone, 17-OH-progesterone (hydroxyprogesterone), DHEA sulfate, etc.

Among all endocrine diseases in gynecological practice, the most common pathology of the thyroid gland and the hyperandrogenism we are considering. To understand this problem, it is necessary to describe a little the androgen synthesis scheme, simplifying it as much as possible:

The whole process is controlled by pituitary hormones - ACTH (adenocorticotropic hormone) and LH (luteinizing hormone).

The synthesis of all steroid hormones begins with the conversion of cholesterol to pregnenolone. It is important to understand the following - this stage occurs in all steroid-producing tissues!

The rest of the processes also, to one degree or another, occur in all organs related to steroidogenesis, however, at the output in different organs, both the same and different steroid hormones are produced. You can depict this in this simplified diagram:

This scheme is simplified as much as possible. Most of the steroids produced by these organs are not represented here. Only the most important and final products are marked.

In addition, it must be added that the production of steroid hormones can occur not only in these organs, but also in the periphery. In particular, for a woman, subcutaneous adipose tissue plays an important role in the production of steroids.

Symptoms of hyperandrogenism

Among all the symptoms of hyperandrogenism, the following predominate:

Causes of hyperandrogenism

Conditions accompanied by hyperandrogenism:

Polycystic ovary syndrome(Stein-Leventhal syndrome) - a combination of amenorrhea and bilateral multiple ovarian cysts. In this case, the most common: menstrual irregularities, infertility, hirsutism and obesity. The diagnosis is made by the presence of hyperandrogenism and chronic anovulation. The risk of insulin resistance and hyperinsulinemia is increased, diabetes mellitus is observed in 20% of patients.

Ultrasound for PCOS

Cushing's syndrome- a condition characterized by an excess of glucocorticoid production by the adrenal glands. In most patients, weight gain is noted with fat deposition on the face (moon-shaped face), neck, and trunk. Typically: hirsutism; violation of menstrual function, infertility; limb muscle atrophy, osteoporosis; decrease in immunoresistance; impaired glucose tolerance; depression and psychosis; in men - possibly gynecomastia and impotence.
There are the following variants of the syndrome:
A. ACTH (adenocorticotropic hormone produced by the pituitary gland) dependent syndrome:
Pituitary - most often tumor lesion of the pituitary gland
Ectopic - secretion of ACTH (or corticoliberin) by a tumor, any location
B. ACTH independent syndrome:
Adrenal - cancer, adenoma, or hyperplasia of the adrenal cortex
Exogenous - self-medication with glucocorticoid drugs or treatment of another pathology, with the forced intake of these drugs

Congenital adrenal hyperplasia- hereditary genetic disease. The following forms are important:

21-hydroxylase deficiency (90-95% of cases) - Aldosterone deficiency is a common cause. It is characterized by: acidosis (shift of the acid-base balance in the body towards an increase in acidity); pathology of the development of the external genital organs.
Deficiency of 11β-hydroxylase - a violation of the formation of cortisol. It is characterized by: the classical form - virilization, arterial hypertension, myocardial hypertrophy, retinopathy, pathology of the development of the external genital organs; non-classical form - hirsutism, acne, menstrual irregularities.
Deficiency of 3 β-hydroxysteroid dehydrogenase - it can be suspected of elevated levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate with normal or slightly elevated levels of testosterone and androstenedione.

Androgen-secreting tumors of the ovaries and adrenal glands- most often this pathology is characteristic of people with severe virilization or with its sharp appearance and rapid progression. At the same time, an increase in testosterone levels is more typical for ovarian tumors, and an increase in dehydroepiandrosterone sulfate is more typical for adrenal tumors. Most often occurs when:

Granulosa cell tumor of the ovary,
Tekome yayinika,
Ovarian androblastoma,
Steroid cell tumors of the ovaries (febrile luteoma, leydigoma),
Adrenal adeoma - 90% of all ovarian tumors, which are characterized by the production of only androgens.

Stromal ovarian hyperplasia and hyperthecosis- observed most often after 60-80 years. The ratio of estradiol and estrone levels is increased.
It is characterized by: hyperandrogenism, obesity, arterial hypertension, impaired glucose tolerance and cancer of the uterine body.

The pathologies presented above are most often accompanied by hyperandrogenism, but this list can be significantly supplemented. In view of the impossibility of describing everything in one article, we considered it reasonable to present only the basic pathology.

Diagnostics of the hyperandrogenism

The first and main method in the diagnosis of hyperandrogenic conditions is a laboratory blood test for the content of steroid hormones. Stepping back not for long to the side, we give the indicators of the norm for steroid hormones in the blood:

Norms for women:

Testosterone - 0.2-1.0 ng / ml or 0.45 - 3.75 nmol / L
Estradiol - 0.17 ± 0.1 nmol / L - follicular phase, 1.2 ± 0.13 nmol / L-ovulation, 0.57 ± 0.01 nmol / L - luteal phase.
Progesterone - 1.59 ± 0.3 nmol / L - folliculin phase, 4.77 ± 0.8 nmol / L - ovulation, 29.6 ± 5.8 nmol / L - luteal phase
Cortisol - 190-750 nmol / l
Aldosterone - 4-15 ng / ml

In addition, you need to know the norms of hormones that affect the production of steroids:
LH - follicular phase - 1.1 - 11.6 mIU / l, ovulation 17 - 77 mIU / l, luteal phase 0 -14.7 mIU / l
ACTH - 0 - 46 pg / ml
FSH - folliculin phase - 2.8-11.3 mIU / l, ovulation - 5.8 - 21 mIU / l, luteal phase - 1.2 - 9.0 mIU / l

The variety of diseases that are accompanied by hyperandrogenic states predisposes the consideration of diagnostic methods (as well as treatment) separately for each disease. Consider the methods for diagnosing the pathologies described above:

Polycystic Ovary Syndrome (PCOS):

History and examination data (see above)
Blood test for hormones - usually there is an equalization of the ratio of testosterone and LH; possible change in the level of FSH; in 25% of cases, hyperprolactinemia; increased glucose levels
Ultrasound - ovarian enlargement and bilateral multiple cysts
Laparoscopy - rarely used, as a rule, for pain syndrome of unknown origin, when for any reason it is not possible to perform ultrasound

Cushing's Syndrome:

In the general analysis of blood - leukocytosis; lymphopenia and eosinopenia.
A blood test for hormones is a simultaneous excess of sex hormones synthesized by the adrenal glands.
Ultrasound examination - possibly for the diagnosis of the ectopic form (detection of tumors localized outside the adrenal glands) and the adrenal form (for the diagnosis of large adrenal tumors).
MRI (magnetic resonance imaging) - with suspicion of oncology, with uninformative ultrasound.
Craniography - X-ray examination of the skull in 2 projections for the diagnosis of pituitary pathologies (deformation of the sella turcica - the location of the pituitary gland in the sphenoid bone of the skull).

Increase in serum 17-hydroxyprogesterone with 21-hydroxylase deficiency (above 800 ng%); it is possible to conduct a test with ACTH. It is important to note that a similar condition can be detected in fetuses even before birth and treatment can be started in the womb - diagnostics at a high risk of this pathology consists in examining the amniotic fluid for the level of progesterone and androstenedione.
Tests with ACTH are also carried out to diagnose deficiency of 11β-hydroxylase and 3 β-hydroxysteroid dehydrogenase.

Androgen-secreting tumors:

Blood test for hormones - increasing the level of androgens - testosterone for ovarian tumors; dehydroepiandrosterone - for adrenal tumors
Pelvic ultrasound - for ovarian tumors.
CT (computed tomography) and MRI - mainly for adrenal tumors.
Catheterization of the adrenal vein with the determination of testosterone levels is a controversial method due to the large number of complications.
Abdominal and pelvic scintigraphy with I-cholesterol.

Blood test for hormones - ovarian androgen levels are usually equal to the male norm.
Gonadotropic hormone levels are usually normal - differential diagnosis from PCOS

Treatment of hyperandrogenism

PCOS:

Drug treatment
A. Medroxyprogesterone - effective for hirsutism. 20-40 mg / day injected or 150 mg intramuscularly 1 time in 6-12 weeks.
B. Combined oral contraceptives - reduce the secretion of steroid hormones, reduce hair growth in 70% of patients with hirsutism, treat acne, eliminate dysfunctional uterine bleeding. Low androgenic PK are preferred: desogestrel, gestodene and norgestimate.
B. Glucocorticoids - dexametozone - 0.25 mg / day (no more than 0.5 mg / day).
G. Ketoconazole - 200 mg / day - inhibits steroidogenesis.
D. Spironalactone 200 mg / day for 6 months. - improvement in 70-80% of patients - with hirsutism; possible menstrual irregularities

Surgical treatment - if drug treatment is ineffective:
A. Wedge-shaped resection was once popular, now this method is no longer so often used in hospitals
B. Laparoscopic electrocoagulation of the ovaries - coagulate (cauterize) the ovary at 4-8 points with an electrode

Cushing's Syndrome:

ACTH dependent
A. Medical treatment - unfortunately, in many cases the diagnosis is rather late. Medical treatment is more often seen as preparation for surgery, rather than as an independent method of treatment. Steroidogenesis inhibitors are used, most often ketoconazole - 600-800 mg / day
B. Surgical treatment - adenomectomy is performed, which, with microadenomas (less than 1 cm tumor size), positive results were noted in 80% of patients; with macroadenomas - in 50%.
B. Radiation therapy - usually with pituitary gland pathology. Positive results in adults in 15-25% of cases.

ACTH is an independent - most often the only radioactive method of treatment for adrenal tumors - an operation followed by the administration of glucocorticoids in the postoperative period and mitotane to prevent relapses.

Congenital adrenal hyperplasia:

Dexametozone - to suppress the secretion of ACTH, at a dose of 0.25 - 0.5 mg / day by mouth. Treatment is carried out under the control of cortisol (if its level is at least 2 μg%, then the treatment is carried out effectively without subsequent complications from the hypothalamic-pituitary system).
It was mentioned above that the detection of pathology and its treatment is possible even in the womb (for deficiency of 21-hydroxylase). Dexametozone is used at a dose of 20 μg / kg / day in 3 divided doses. With a high risk of the formation of pathology in a child, treatment begins from the moment pregnancy is detected. If the fetus turns out to be male, the treatment is stopped, if the female fetus is continued. If treatment is started before 9 weeks of pregnancy and before delivery, the risk of pathology in the formation of genital organs is much less. This treatment regimen is the subject of controversy among specialists, who indicate that a large number of complications for the mother are possible with a rather low effectiveness of the treatment itself.

Androgen-secreting tumors of the ovaries and adrenal glands

Treatment only in an oncological hospital, most often an operation in combination with chemotherapy, radiation or hormonal therapy. The prognosis of treatment depends on the time of diagnosis and the nature of the tumor itself.

Stromal ovarian hyperplasia and hyperthecosis:

With a mild form, wedge-shaped resection of the ovaries is effective. The use of analogs of gonadoliberin is possible. In severe pathology, bilateral ovarian amputation is possible in order to normalize blood pressure and correct impaired glucose tolerance.

With the onset of symptoms of hyperandrogenism, it is imperative to consult a doctor. Most often - an endocrinologist or gynecologist, often a therapist. It is imperative to understand in detail the causes of hirsutism and other symptoms, and, if necessary, send to a specialized hospital.

Any self-medication is completely and categorically contraindicated! Only hair removal with cosmetic products is permissible.

Prevention of hyperandrogenism

Hyperandrogenism has no specific preventive measures. The main ones include adherence to a proper diet and lifestyle. Every woman needs to remember that excessive weight loss contributes to hormonal disorders and can lead to both the described condition and many others. In addition, one should not get involved in sports, which also (especially when taking steroid drugs) can lead to hyperandrogenism.

Rehabilitation is required by patients with tumor hyperandrogenism who have undergone surgical and chemotherapeutic treatment. In addition, consultation with a psychologist is mandatory, especially for young girls with severe hirsutism and gynecological problems.

Complications of hyperandrogenism

The spectrum of possible complications for all the diseases described above is extremely large. Only some of the most important ones can be noted:

With congenital pathology, developmental anomalies are possible, the most common of which are developmental anomalies of the genital organs.
Metastasis of malignant tumors is a complication more characteristic of adrenal tumors.
Complications from other organ systems that are negatively influenced by changes in hormonal levels in the pathology of the adrenal glands, pituitary gland and ovaries: chronic renal failure, thyroid pathology, etc.

Doctor gynecologist-endocrinologist Kupatadze D.D.