Hyperandrogenemia

Introduction In the follicular phase of the normal menstrual cycle, the serum testosterone concentration is 0.43 ng/ml on average, and the upper limit is 0.68 ng/ml. If it exceeds 0.7 ng/m1 (equal to 2.44 nmol/L), it is called high testosteroneemia, or high androgen. Blood. Ovarian, adrenal cortex, etc. can synthesize cholesterol from acetic acid, or absorb cholesterol from the blood as a matrix, synthesize steroid hormones, and secrete into the blood circulation. High testosteroneemia, which is formed by the high levels of these hormones, especially testosterone in the blood. More common are menstrual changes such as menstrual thinning, amenorrhea or dysfunctional uterine bleeding, no ovulation, infertility. Some have masculine changes, such as hairy, enlarged throat, and low pitch. Some obesity, hemorrhoids, breast dysplasia, poor uterine development, ovarian enlargement, a few cases of clitoris hypertrophy.

Cause

Causes:

About 34% of patients with polycystic ovary syndrome, followed by adrenal hyperfunction accounted for 29%, a few found in follicular hyperplasia and adrenal hyperplasia, about 28% of unknown sources. It has recently been reported that hyperinsulinemia can stimulate the ovary to secrete large amounts of androgen into hypertestosterone. Its etiology is complex, and a series of reproductive system development and dysfunction can occur in the clinic. Polycystic ovary syndrome is the most important cause of hyperandrogenism in women. Almost all patients with polycystic ovary syndrome have elevated androgen, or decreased androgen-binding protein, increased free androgen, and enhanced activity.

an examination

Related inspection

Urine testosterone testosterone plasma dihydrotestosterone (DHT) pelvic and vaginal B-ultrasound

Clinical examination:

According to clinical manifestations, especially menstrual thinning, amenorrhea or dysfunctional uterine bleeding, plus some masculinity characteristics should consider the possibility of this disease.

The diagnosis is based on an increase in blood testosterone >0.7 ng/ml or >2.44 nmol/L. Others, such as B-ultrasound, clomiphene test and other auxiliary examinations can help diagnose the normal secretion of gonadotropin, the ovary does not increase, but the follicular cells are nest (island) hyperplasia, plasma androgen increased significantly, with severe masculinization. Not sensitive to chlorophenolamine treatment.

Differential diagnosis

During the follicular phase of the normal menstrual cycle, the serum testosterone concentration averaged 0.43 ng/ml and the upper limit was 0.68 ng/ml. For example, more than 0.7 ng / ml (= 2.44nmol / L), that is, hyperandrogenemia, also known as high testosteroneemia, is a common gynecological endocrine disease.

First, ovarian masculinizing tumors: including support for a stromal cell tumor, portal cell tumor, lipoblastoma, myxoma, adrenal residual tumor, lutocytoma, teratoma and metastatic cancer. In addition to the above-mentioned dystrophic blastoma, other tumors are mostly unilaterally growing solid tumors, and the androgen secretion is autonomic, masculine symptoms are obvious, and often accompanied by ascites and metastases.

Second, adrenal diseases: including congenital adrenal hyperplasia, adenoma and adenocarcinoma. The latter two mainly secrete androstenedione and DHEA, which are also autonomously secreted, not promoted by ACTH and inhibited by dexamethasone. Congenital adrenal hyperplasia, 21 hydroxylase deficiency, typical vulvar-genitourinary sinus malformation with dysplasia.

Third, thyroid disease: including hyperthyroidism and hypothyroidism. At the time of hyperthyroidism, T3, T4, and SHBG increased, and the androgen clearance rate decreased, which caused the increase of plasma testosterone to cause masculinization and menstrual disorders. When hypothyroidism occurs, the conversion of androgens to estrogen increases to cause anovulation.

Fourth, hereditary hirsutism: a family history, only simple hairy without PCOS symptoms and signs. Fertility is normal.

V. Ovarian follicular cell hyperplasia: The gonadotropin secretion is normal, the ovary does not increase, but the follicular cells are nest (island) hyperplasia, and the plasma androgen is elevated significantly, with severe masculinization. Not sensitive to chlorophenolamine treatment.

Sixth, insulin anti-allergic syndrome and melanin acanthoma: an adiponectin receptor-deficient disease (A / B type), can appear similar to PCOS symptoms and signs. Its prominent features are hyperinsulinemia and melanoma of the neck and palate.

Seven, hyperprolactinemia: amenorrhea, galactorrhea, infertility, PRL and DHEAS increased, masculine symptoms are not obvious, ovarian normal.

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