Hyperandrogenism - a pathological condition of the endocrine system of the female body, is caused by excessive synthesis of sex hormones by the ovaries or male pattern adrenal cortex.Hyperandrogenism syndrome refers to the most common endocrine pathology observed only among the females at different ages on a par with the incidence of thyroid cancer.
In determining the tactics of monitoring and treatment of patients who are showing signs of hyperandrogenism, it should be noted that this pathology is not identified with increased levels of androgen in the blood serum gomronov.Many women may experience clinical criteria of hyperandrogenism symptoms and laboratory signs of missing enhance the content of androgens in the blood circulation.
Causes of hyperandrogenism
pathogenetic mechanisms of hyperandrogenism are either excessive synthesis of male hormones by the adrenal glands and ovaries, or increased formation of androgenic hormone precursors.In some situations, the dev
rare etiopathogenetic mechanism of hyperandrogenism is significantly reduced levels of globulins, responsible for the binding of sex hormone.The action of the globulin is intended to prevent the penetration of the androgenic hormone into the cell, thereby disrupting the interaction of androgenic hormones with specific receptors.On the production of androgen hormones exerts indirect influence state gormonsinteziruyuschey thyroid function, so a variety of pathological changes in the endocrine organs inevitably provoke a syndrome of hyperandrogenism.
There are a number of diseases associated with varying degrees of intensity hyperandrogenism.For example, in the Stein-Leventhal syndrome, or PCOS, developing ovarian hyperandrogenism, manifestations of which often becomes dysmenorrhea, obesity, increased body hair, as well as the impossibility of conception and gestation.The cause of postmenopausal ovarian hyperandrogenism form can be gipertekoz in which patients worried about obesity, propensity to hypertension, while the instrumental investigation sometimes shows signs of adenocarcinoma of the uterus and reduce glucose tolerance.
Adrenal hyperandrogenism in the classic version developed with congenital adrenal hyperplasia, which belongs to the category of inherited genetic diseases.For this disease is characterized by the presence of congenital and subsequent progression of the following clinical signs: hypertension, virilization, myocardial hypertrophy, anomalies of the external genitalia, and retinopathy.Fortunately, this pathology is rare, but there are other pathological syndrome, hyperandrogenism provoking, entitled "Cushing's syndrome".For the development of this syndrome, accompanied by the appearance of clinical signs of hyperandrogenism, often resulting in lesions of the adrenal glands, but in some situations, Cushing's syndrome develops when exposed to high doses of exogenous glucocorticoid drugs, which are used in a wide range of pathological conditions of the human body.
separate category of patients with signs of hyperandrogenism are patients tumor of the ovaries and adrenal glands, as has recently been a significant increase in the incidence of androgensekretiruyuschimi forms of cancer.
symptoms of hyperandrogenism
Hyperandrogenism women who are of childbearing age is accompanied by a wide spectrum of clinical manifestations, each symptom that can be attributed to one of three major syndromes: gynecological, dismetabolic and beauty.
In the debut of the disease in women there are various forms of violations of the menstrual cycle, which manifests itself in his irregularities, until the development of amenorrhea, which is directly dependent on the level of androgenic hormones in the blood circulation.A lot of women suffering from hyperandrogenism, there is a tendency to development of anovulatory menstrual cycle, triggered by lack of progesterone in the blood and on the other hand an increase in estrogen levels.In addition to violations of ovulation, the hormonal imbalance for a brief period triggers the development of hyperplastic processes in the endometrium until the proliferation of neoplastic processes.In this regard, hyperandrogenism related to precipitating factors of secondary infertility.
In a situation where girls hyperandrogenism is congenital in nature, form anomalies of the external genitalia in the form of hypertrophy of the clitoris, partial fusion of the labia majora, the urogenital sinus.
Symptom cosmetic defect includes hirsutism and various forms of skin lesions.Hirsutism, or increased body hair is the most common and pathognomonic clinical criteria of hyperandrogenism and is to strengthen the growth of hair in the projection of the middle line of the abdomen, face, side of the neck and chest with a simultaneous loss of hair on the head.Women with hyperandrogenism more than others prone to develop common skin rash type of severe acne and dry skin with patches of excessive flaking.
Signs dismetobolicheskih violations that occur in any form of hyperandrogenism, is the occurrence of overweight, atrophy of muscle fibers and the formation of impaired glucose tolerance, which is the agent provocateur of diabetes, obesity and dismetabolic cardiomyopathy.
pretty specific manifestation of hyperandrogenism is barifoniya, which involves deepening of voice, which has nothing to do with organic pathology of the vocal cords.In a situation where the signs of hyperandrogenism develop at a young age, there is increased development of muscular torso array with a maximum redistribution in the upper half of the chest, shoulder girdle.
Among the possible causes of miscarriage in pregnant women in the first trimester, hyperandrogenism is a leader.Unfortunately, during the detection of signs of hyperandrogenism in women during pregnancy is already available is extremely difficult to identify congenital or acquired the character of a given pathology.During this period, the definition of origin of the disease has such a big deal, as a matter of priority to implement all necessary measures to preserve the pregnancy.
Phenotypic signs of hyperandrogenism in pregnant women do not differ from the symptoms of the disease state of any other representative of the female sex, the only difference is that in some situations, hyperandrogenism is manifested in the form of abortion in early pregnancy, which is not always regarded women as miscarriage.Development of miscarriage in early pregnancy due to lack of attachment of the ovum to the uterine wall and its rejection of even the slightest traumatic impact.A striking clinical manifestation of this condition is the detection of vaginal bleeding, which by the way, may not be so intense, pulling pain in the suprapubic region and leveling signs of early toxicity.
After 14 weeks of gestation are physiological conditions to prevent the fact of termination of pregnancy, since in this period the increase in the activity of female sex hormones secreted by the placenta in large quantities.
Another critical period of a threat of termination of pregnancy in women with hyperandrogenism is 20 weeks of pregnancy when there is an active release of dehydroepiandrosterone by the adrenal glands of the fetus, which inevitably provokes strengthening androgenization pregnant woman.Complication these pathological changes is the development of signs of cervical incompetence, which could trigger the onset of premature delivery.In the third trimester of pregnancy is a provocateur hyperandrogenism early rupture of membranes, so that a woman can give birth prematurely.
to determine hyperandrogenism in a pregnant woman it is advisable to use a laboratory diagnostic techniques, fundamentally different from the rest of the survey categories of patients.In order to determine the concentration of male hormones necessary to examine the urine of a pregnant woman with the definition of "the amount of 17-ketosteroids."
Note that not all cases of signs of hyperandrogenism in a pregnant woman must undergo medical correction, even with the confirmation of the diagnosis by laboratory methods.Pharmacological therapies are applied only in the case of existing threat gestation.The drug of choice for the treatment of hyperandrogenism in pregnancy is Dexamethasone, the initial daily dose of which is ¼ tablet, the effect of which is directed to the inhibition of the pituitary gland, have an indirect effect on the production of male hormones.The use of this medication is justified by the complete absence of adverse effects on fetal development while the positive effect against leveling signs of hyperandrogenism.
In the postpartum period, women with hyperandrogenism, must be supervised not only a gynecologist, but also endocrinologist, since this pathological condition tends to progress and provoke serious complications.
fundamental link among all possible diagnostic procedures when hyperandrogenism is a laboratory evaluation levels of steroid hormones.In addition to the definition of steroid hormones it is advisable to exercise control over the content of the hormones involved in the regulation of steroid production.
Due to the fact that hyperandrogenic a consequence of a number of diseases of different mechanisms and clinical manifestations and diagnostic criteria for each of these pathologies are different.
Thus, in polycystic ovary syndrome marked balancing parameters of luteinizing hormone and testosterone, FSH decline, and in some cases - increase prolactin levels.Nonspecific laboratory signs of hyperandrogenism in polycystic ovary is an increased concentration of glucose in the blood.Ultrasound scan transvaginal access method allows almost 100% of the change in the structure to visualize cystic ovarian parenchyma, accompanied by an increase in the general parameters of the ovaries.
Cushing's syndrome is accompanied not only by a change in hormonal status and nonspecific laboratory findings in the form of leukocytosis, lymphopenia and eosinopenia.Hormonal imbalance is detected, the excess hormone produced by the adrenal glands into the blood serum.Ray imaging techniques used in this situation as the diagnosis of primary tumor process localized in the adrenal glands, but the most informative in terms of detection of smaller tumors has magnetic resonance imaging.Due to the fact that Cushing's syndrome with concomitant hyperandrogenism may develop as a consequence of pathological changes in the pituitary gland, in the range of screening patients in this category certainly includes craniography with roentgenometer sella.
diagnosis of congenital adrenal hyperplasia should be performed in utero fetal life by the study of amniotic fluid level indicator for androstenedione and progesterone.Pathognomonic signs of this disease is an increase in serum 17-hydroxyprogesterone over 800ng%.
If you suspect the presence of a tumor in a patient adrenosekretiruyuschey ovarian or adrenal special attention should be paid to assessing the performance of testosterone and DHEA levels which increased in these pathologies.As additional diagnostic procedures, conduct necessary for evaluating possible surgical treatment of tumor, radiation imaging techniques are used, as well as magnetic resonance imaging.
Treatment of hyperandrogenism
hyperandrogenism choice of treatment depends on the underlying disease that caused the development of the pathological condition, as well as the severity of the disease and the severity of symptoms of hyperandrogenism lab.In this regard, the management of patients and determining the treatment strategy should be mainly individual, taking into account all the peculiarities of each individual patient.In many situations, the treatment of hyperandrogenism means carrying out a whole range of therapeutic measures both conservative and operative areas.
polycystic ovarian syndrome is the most common cause of ovarian hyperandrogenism, in many cases respond well to conservative treatment with the use of a whole range of hormones.Available patient symptoms of hirsutism are the basis for the use of Medroxyprogesterone 150 mg parenterally one time in three months before leveling clinical impairment or long-term use of spironolactone in a daily dose of 200 mg, which also has a positive effect on the normalization of the menstrual cycle.In order to eliminate uterine bleeding and prevent, treat acne and reduce the appearance of hirsutism used oral contraceptives combined action (Norgestimate in an average daily dose of 250 mg orally).Note, however, that all members of this group of drugs are not without side effects, so there are a number of states, it is an absolute contraindication to their use (thrombosis of any location, severe hepatic parenchymal tumor of any localization process, the presence of endometrial foci).To suppress steroidogenesis recommended daily ketoconazole in 200 mg.Operative treatment of polycystic ovaries, as a rule, applied only if the total absence of the effect of ongoing medical correction, as well as the spread of diffuse cystic changes of ovarian parenchyma.Currently, the most efficient and sparing operational tool in polycystic ovarian electrocoagulation considered ovarian laparoscopic access.
When Cushing's syndrome with signs of hyperandrogenism in patients suffering from adrenal cancer pathology, the only effective treatment is surgery.The preparatory phase prior to surgical treatment is the use of drugs, the effect of which is aimed at the suppression of steroidogenesis (ketoconazole, a daily dose of 600 mg).The effectiveness of surgical treatment depends on the size of the tumor, so when an amount not exceeding 10 mm positive result is achieved in 80% of cases.Postoperatively, prophylactic treatment is advisable to apply Metotanom at a dose of 10 g to prevent recurrence of tumor growth substrate.
Treatment of congenital adrenal hyperplasia should be started as early as the stage of prenatal development of the child, as this pathology leads to the development of severe hyperandrogenism.