Gynecology Book

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HyperandrogenismAka: Hyperandrogenemia, Androgen Excess

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  1. Symptoms and Signs
    1. General appearance
      1. Muscular male body habitus (e.g. shoulder girdle)
      2. Android Obesity
    2. Miscellaneous Changes
      1. Deepening of voice
      2. Clitorimegaly
      3. Increased Libido
    3. Menstrual irregularity
      1. Amenorrhea
      2. Infertility
    4. Endocrine changes
      1. Hypertension
      2. Hyperlipidemia
      3. Glucose Intolerance
    5. Skin changes
      1. Hirsutism involving face, chin, chest and perineum
      2. Alopecia
        1. Vertex or crown Hair Loss
        2. Bitemporal Hair Loss may also occur
      3. Acanthosis Nigricans (HAIR-AN Syndrome)
      4. Oily skin
      5. Acne Vulgaris
      6. Male sweat changes (malodorous perspiration)
  2. Hyperandrogenic Syndromes
    1. HAIR-AN Syndrome
    2. Polycystic Ovary Disease (Stein-Leventhal Syndrome)
  3. Causes
    1. See Hyperandrogenism Causes
  4. Labs
    1. Serum Testosterone (normally 20-80 ng/dl)
      1. Measure on 2 separate occasions
      2. Level <200: Hyperandrogenic chronic Anovulation
      3. Level >200: Assess for virilizing tumor
    2. Serum 17a-HydroxyProgesterone (normally <2 ng/ml)
      1. Test >4 ng/ml suggests Congenital Adrenal Hyperplasia
      2. Check adrenocorticotropic stimulation test
    3. Dehydroepiandrosterone sulfate (normal 250-300 ng/dl)
      1. DHEAS <700 ng/dl: Hyperandrogenic chronic Anovulation
      2. DHEAS >700 ng/dl: Adrenal tumor secreting androgens
    4. Other labs to consider
      1. Dexamethasone Suppression Test (AM Serum Cortisol)
        1. Assess for Cushing's Syndrome
      2. Luteinizing hormone and Follicle Stimulating Hormone
        1. Assess for ovarian tumors
      3. Lipid profile
        1. Lipids elevated in Hyperandrogenism
  5. References
    1. Elmer (2001) Am Fam Physician 63(12):2385
    2. Redmond (1998) J Fertil Womens Med 43:91

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