What sign contradicts hyperandrogenism. Hyperandrogenism: causes of increased male sex hormones in women, and what treatment is needed

Hyperandrogenism in women is a condition in which the blood is determined elevated level androgens, as well as clinical data of an excess of male sex hormones. It occurs in different age groups. The main causes of hyperandrogenism are adrenogenital syndrome (AGS) and polycystic ovaries (PCOS). Treatment of hyperandrogenism is aimed at correcting the hormonal background and preventing the consequences of androgen excess.

Normally, the hormonal status of a woman allows a certain level of androgens in the blood. From them, under the action of aromatase, part of the estrogens is formed. An excess amount leads to a violation reproductive function, increased risk oncological diseases. The ICD-10 does not classify this syndrome, as it is not a disease.

What causes hyperandrogenism in women

Hyperandrogenism is characterized by an increased concentration in the female body of androgens, which are male sex hormones, among which testosterone is best known. In the fair sex, the adrenal cortex, ovaries, subcutaneous adipose tissue and indirectly the thyroid gland are responsible for their synthesis. The whole process is "managed" by luteinizing hormone (LH), as well as adrenocorticotropic hormone (ACTH) of the pituitary gland.

In normal concentration, androgens in the female body exhibit the following properties:

• responsible for growth- participate in the growth spurt mechanism and contribute to the development of tubular bones during puberty;
• are metabolites- they form estrogens and corticosteroids;
• form sexual characteristics- at the level with estrogens, they are responsible for the natural hair growth in women.

The excess content of androgens leads to hyperandrogenism, which manifests itself in endocrinological, cyclic disorders, changes in appearance.

The following primary causes of hyperandrogenism can be distinguished.

• AGS. Adrenogenital syndrome is characterized by insufficient synthesis or lack of production by the ovaries of the enzyme C21-hydroxylase (converts testosterone to glucocorticoids), which leads to an excess of androgens in the female body.
• Polycystic. PCOS can be the cause of androgen excess or a consequence.
• Tumors. They can be localized in the ovaries, adrenal glands, in the pituitary gland and hypothalamus, while they produce an excessive amount of androgens.
• Other pathologies. Hyperandrogenism can be caused by a malfunction of the thyroid gland, liver (here hormone metabolism occurs), taking hormonal drugs.

These disorders lead to a change in the metabolism of male sex hormones, and there is:

• their excessive education;
• conversion to active metabolic forms;
• increased sensitivity of receptors to them and their rapid death.

Additional factors that may affect the development of hyperandrogenism are:

• taking steroids;
• elevated prolactin levels;
• overweight in the first years of life;
• sensitivity (sensitivity) of the skin to testosterone.

Varieties of pathology

Depending on the cause, level and mechanism of development of pathology, the following types of hyperandrogenism are distinguished.

• Ovarian. It is characterized by disorders of genetic or acquired origin. Ovarian hyperandrogenism is characterized by rapid development and sudden onset of symptoms. In the ovaries, androgens are converted to estrogens by the enzyme aromatase. In case of violation of its work, there is a deficiency of female sex hormones and an excess of male ones. In addition, ovarian hyperandrogenism can be provoked by hormonally active tumors of this localization.
• Adrenal. Such hyperandrogenism is caused by tumors of the adrenal glands (most often androsteromas) and adrenogenital syndrome. The latter pathology is caused by genetic abnormalities of the gene that is responsible for the formation of the C21-hydroxylase enzyme. The lack of this substance for a long time can be compensated for by the work of other hormone-producing organs, so the condition has a latent course. With psycho-emotional overstrain, pregnancy and other stress factors, the enzyme deficiency is not covered, so the AGS clinic becomes more obvious. Adrenal hyperandrogenism is characterized by ovarian dysfunction and menstrual cycle, lack of ovulation, amenorrhea, insufficiency of the corpus luteum during egg maturation.
• Mixed. A severe form of hyperandrogenism combines ovarian and adrenal dysfunction. The trigger mechanism for the development of mixed hyperandrogenism is neuroendocrine disorders, pathological processes in the hypothalamus. Manifested by violations of fat metabolism, often infertility or miscarriage.
• Central and peripheral. Associated with dysfunction of the pituitary and hypothalamus, disruption of the nervous system. There is a deficiency of follicle-stimulating hormone, which disrupts the maturation of the follicles. As a result, the level of androgens rises.
• Transport. This form of hyperandrogenism is based on a deficiency of globulin, which is responsible for the binding of sex steroids in the blood, and also blocks the excessive activity of testosterone.

According to the focus of the onset of pathology, the following types of hyperandrogenism are distinguished:

• primary - originates in the ovaries and adrenal glands;
• secondary - the center of origin in the pituitary gland.

According to the way the pathology develops, the following are distinguished:

• hereditary;
• acquired.

According to the degree of concentration of male hormones, hyperandrogenism occurs:

• relative - the level of androgens is normal, but the sensitivity of target organs to them is increased, and male sex hormones tend to turn into active forms;
• absolute - the permissible norm of the content of androgens is exceeded.

How does it manifest

Hyperandrogenism is manifested by vivid signs, often they are easy to notice even for the layman. Symptoms of excessive concentration of male hormones depend on the age, type and degree of development of the pathology.

Before puberty

Prior to puberty, hyperandrogenism is due to genetic disorders or hormonal imbalances during fetal development.
It is clinically manifested by defective anatomy of the external genitalia and pronounced male secondary sexual characteristics.

Adrenal hyperandrogenism in newborn girls is manifested by false hermaphroditism - the vulva is fused, the clitoris is excessively enlarged, the fontanel is overgrown already in the first month. Subsequently, the girls observed:

• long upper and lower limbs;
• high growth;
• excessive amount of hair on the body;
• late onset of menstruation (or absent at all);
• secondary female sexual characteristics are weakly expressed.

Diagnosis is difficult to carry out with this pathology and ovotestis - the presence of male and female germ cells, which happens with true hermaphroditism.

At puberty

During puberty, girls with hyperandrogenism may experience:

• acne on face and body- clogging of the ducts of the sebaceous glands and hair follicles;
• seborrhea - excessive secretion production by the sebaceous glands;
• hirsutism - excessive growth of hair on the body, including in "male" places (on the arms, back, inner thighs, chin);
• NMC - unstable menstrual cycle, amenorrhea.

At reproductive age

If the pathology manifested itself in the reproductive age, all of the above signs can be joined by:

• baryphony - coarsening of the voice;
• alopecia - baldness, hair loss on the head;
• masculinization - increase muscle mass, change in the figure according to the male type, redistribution of subcutaneous fat from the hips to the abdomen and upper half of the body;
• increased libido- excessive sexual desire;
• breast reduction- mammary glands are small, lactation persists after childbirth;
• metabolic disease- is expressed in insulin resistance and the development of type 2 diabetes mellitus, hyperlipoproteinemia, obesity;
• gynecological problems- disruptions in the menstrual cycle, lack of ovulation, infertility, endometrial hyperplasia;
• psychoemotional disorders- a tendency to depression, a feeling of loss of strength, anxiety, sleep disturbance;
• cardiovascular disorders- Tendency to hypertension, episodes of tachycardia.

All these symptoms are combined into one concept - the viril syndrome, which implies the development of male characteristics and the loss of female characteristics by the body.

In menopause

In women with the onset of menopause, a syndrome of hyperandrogenism occurs due to a decrease in estrogen levels. By this time, many note the appearance of "male hair", especially in the chin and upper lip. This is considered normal, but hormone-producing ovarian tumors must be ruled out.

Diagnostics

Confirmation of pathology requires a comprehensive examination.

• Collection of anamnesis. Information about the menstrual cycle, the physique of a woman, the degree of hair coverage of her face and body, the timbre of her voice are taken into account - those signs that indicate an excess of androgens.
• Blood tests . For sugar content and for determining the level of testosterone, cortisol, estradiol, 17-hydroxyprogesterone, SHBG (globulin that binds sex hormones), DHEA (dehydroepiandrosterone). Tests for hormones are carried out on the fifth to seventh day of the cycle.
• ultrasound. It is necessary to carry out ultrasound procedure thyroid gland, adrenal glands and pelvic organs.
• CT, MRI. If you suspect a brain tumor in the pituitary gland or hypothalamus.

If necessary, the range of examinations can be expanded for more detailed diagnostics.

Consequences for the body

Estrogens are responsible not only for the "feminine appearance" and the realization of reproductive potential, but also protect the body from many pathological conditions. An imbalance between estrogens and androgens can lead to the following consequences:

• problems with pregnancy- infertility, miscarriage in the early and late periods;
• increased risk of developing cancer- endometrium, breast, cervix;
• gynecological diseases- more often there are dysfunctions, ovarian cysts, endometrial hyperplasia and polyps, cervical dysplasia, mastopathy;
• somatic diseases- a tendency to hypertension and obesity, strokes, heart attacks are more common.

Treatment

Treatment of hyperandrogenism in women is aimed at correcting the hormonal imbalance and eliminating the root cause. Clinical recommendations depend on the age of the woman, the realization of her reproductive potential, the severity of symptoms and other disorders in the body.

• Standard Approach. Most often, treatment regimens for this pathology are based on the use of combined hormonal drugs that have an antiandrogenic effect. In some cases, gestagens are enough, for example, Utrozhestan. This therapy is used to correct adrenal and ovarian hyperandrogenism. This tactic does not eliminate the cause of the disease, but helps to fight the symptoms and reduces the risk of complications of hyperandrogenism in the future. It is necessary to take hormones constantly.
• Adrenogenital syndrome. It is stopped with the help of corticosteroids, which are also used in preparing a woman for pregnancy. Among the drugs, the most famous is Dexamethasone. "Veroshpiron" can be used to correct the water-salt balance in AGS.
• Androgen derived tumors. Most of them are benign neoplasms, but they still need to be removed. surgically.

With infertility, it is often necessary to resort to ovulation stimulation, IVF, and laparoscopy if polycystic ovaries are diagnosed. Established hyperandrogenism and pregnancy require careful medical supervision due to the increased risk of pregnancy complications. Reviews of women and doctors confirm this.

Hyperandrogenism in women is a condition in which an increased level of androgens is determined in the blood, and clinical data of an excess of male sex hormones are also recorded.

It occurs in different age groups. The main causes of hyperandrogenism are adrenogenital syndrome (AGS) and polycystic ovaries (PCOS). Treatment of hyperandrogenism is aimed at correcting the hormonal background and preventing the consequences of androgen excess. Normally, the hormonal status of a woman allows a certain level of androgens in the blood. From them, under the action of aromatase, part of the estrogens is formed.

An excessive amount leads to a violation of the reproductive function, increases the risk of cancer. The ICD-10 does not classify this syndrome, as it is not a disease.

What it is?

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. Significance of hyperandrogenism in the structure gynecological pathology due to its wide distribution among women of childbearing age (4-7.5% in adolescent girls, 10-20% in patients older than 25 years).

Causes

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

• increased levels of androgens in the blood serum;
• conversion of androgens to 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 impaired ovarian function. The most common 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, hypothalamus and adrenal glands. The incidence of PCOS among women of childbearing age reaches 5-10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

• adrenogenital syndrome;
• congenital adrenal hyperplasia;
• galactorrhea-amenorrhea syndrome;
• stromal tecomatosis 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 body hair, and in rare cases, hair loss on the head.

Compensatory hyperproduction of insulin stimulates the production of ovarian cells that produce androgens. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptor cells in the tissues of the ovaries, 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;
• excess body weight;
• 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.

Classification

Depending on the cause, level and mechanism of development of pathology, the following types of hyperandrogenism are distinguished.

1. Ovarian. It is characterized by disorders of genetic or acquired origin. Ovarian hyperandrogenism is characterized by rapid development and sudden onset of symptoms. In the ovaries, androgens are converted to estrogens by the enzyme aromatase. In case of violation of its work, there is a deficiency of female sex hormones and an excess of male ones. In addition, ovarian hyperandrogenism can be provoked by hormonally active tumors of this localization.
2. Adrenal. Such hyperandrogenism is caused by tumors of the adrenal glands (most often androsteromas) and adrenogenital syndrome. The latter pathology is caused by genetic abnormalities of the gene that is responsible for the formation of the C21-hydroxylase enzyme. The lack of this substance for a long time can be compensated for by the work of other hormone-producing organs, so the condition has a latent course. With psycho-emotional overstrain, pregnancy and other stress factors, the enzyme deficiency is not covered, so the AGS clinic becomes more obvious. Adrenal hyperandrogenism is characterized by ovarian dysfunction and menstrual irregularities, lack of ovulation, amenorrhea, corpus luteum insufficiency during egg maturation.
3. Mixed. A severe form of hyperandrogenism combines ovarian and adrenal dysfunction. The trigger mechanism for the development of mixed hyperandrogenism is neuroendocrine disorders, pathological processes in the hypothalamus. Manifested by violations of fat metabolism, often infertility or miscarriage.
4. Central and peripheral. Associated with dysfunction of the pituitary and hypothalamus, disruption of the nervous system. There is a deficiency of follicle-stimulating hormone, which disrupts the maturation of the follicles. As a result, the level of androgens rises.
5. Transport. This form of hyperandrogenism is based on a deficiency of globulin, which is responsible for the binding of sex steroids in the blood, and also blocks the excessive activity of testosterone.

According to the focus of the onset of pathology, the following types of hyperandrogenism are distinguished:

• primary - originates in the ovaries and adrenal glands;
• secondary - the center of origin in the pituitary gland.

According to the way the pathology develops, the following are distinguished:

• hereditary;
• acquired.

According to the degree of concentration of male hormones, hyperandrogenism occurs:

• relative - the level of androgens is normal, but the sensitivity of target organs to them is increased, and male sex hormones tend to turn into active forms;
• absolute - the permissible norm of the content of androgens is exceeded.

Symptoms

Symptoms of hyperandrogenism in women can range from mild (excessive growth of body hair) to severe (development of secondary male sexual characteristics).

The main manifestations of pathological disorders are:

• acne - occurs with increased oiliness of the skin, which leads to blockage and inflammation of the sebaceous glands;
• seborrhea of ​​the scalp;
• hirsutism - the appearance of strong hair growth in places atypical for women (face, chest, abdomen, buttocks);
• thinning and hair loss on the head, the appearance of bald patches;
• increased muscle growth, the formation of muscles according to the male type;
• coarsening of the timbre of the voice;
• violation of the menstrual cycle, the scarcity of discharge, sometimes the complete cessation of menstruation;
• increased sex drive.

Occurring failures in the hormonal balance cause the development of diabetes mellitus, the appearance of excess weight, lipid metabolism disorders. Women become very susceptible to various infectious diseases. They often develop depression, chronic fatigue, increased irritability and general weakness.

One of the most severe consequences of hyperandrogenism is virilization or virilization syndrome. This is the name of the pathology of the development of the female body, in which it acquires pronounced male characteristics. Virilization is a rare abnormality, it is diagnosed in only one patient out of 100 who have excessive growth of body hair.

A woman develops a male figure with increased muscle growth, menstruation completely stops, and the size of the clitoris increases significantly. Very often, these signs develop in women who take steroids uncontrollably to increase endurance and physical strength when playing sports.

Hyperandrogenism during pregnancy

Among all the possible causes of spontaneous abortion in a pregnant woman in the first trimester, hyperandrogenism occupies a leading position. Unfortunately, during the detection of signs of hyperandrogenism in a woman during an existing pregnancy, it is extremely difficult to determine whether this pathology is congenital or acquired. In this period, the definition of the genesis of the disease is not so of great importance, since it is first and foremost necessary to carry out all measures to preserve pregnancy.

The phenotypic signs of hyperandrogenism in a pregnant woman are no different from the manifestations of this pathological condition in any other female representative, with the only difference being that in some situations hyperandrogenism manifests itself in the form of an abortion on early term, which is not always regarded by a woman as a miscarriage. The development of spontaneous miscarriage at an early stage is due to insufficient attachment of the fetal egg to the wall of the uterus and its rejection even with 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 toxicosis.

After the 14th week of pregnancy, physiological conditions are created to prevent the fact of abortion, since in this period there is an increase in the activity of female sex hormones secreted by the placenta in large quantities.

Another critical period of the threat of abortion in a woman suffering from hyperandrogenism is the 20th week of pregnancy, when there is an active release of dehydroepiandrosterone by the adrenal glands of the fetus, which inevitably provokes an increase in the androgenization of a pregnant woman. A complication of these pathological changes is the development of signs of isthmic-cervical insufficiency, which can provoke the onset of premature delivery. In the third trimester of pregnancy, hyperandrogenism is a provocateur of early rupture of amniotic fluid, as a result of which a woman can give birth ahead of schedule.

To determine hyperandrogenism in a pregnant woman, it is advisable to use only laboratory diagnostic methods that are fundamentally different from the examination of the rest of the category of patients. In order to determine the concentration of male sex hormones, it is necessary to examine the urine of a pregnant woman with the determination of the “sum of 17-ketosteroids”.

It should be borne in mind that not all cases of revealing signs of hyperandrogenism in a pregnant woman should be subjected to medical correction, even if the diagnosis is confirmed by laboratory methods. Medical methods of therapy are used only in case of an existing threat to the bearing of the fetus. The drug of choice for the treatment of hyperandrogenism during pregnancy is Dexamethasone, the initial daily dose of which is ¼ tablet, the action of which is aimed at inhibiting the function of the pituitary gland, which has an indirect effect on the production of male sex hormones. The use of this drug is justified by the complete absence of a negative effect on fetal development with a simultaneous positive effect in terms of leveling the signs of hyperandrogenism.

IN postpartum period, women suffering from hyperandrogenism must be under the supervision of not only a gynecologist, but also an endocrinologist, since this pathological condition tends to progress and provoke serious complications.

Complications

The range of possible complications in all the diseases described above is extremely large. Only a few of the most important ones can be mentioned:

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

This simple enumeration of the list is far from over, which speaks in favor of a timely visit to the doctor in order to anticipate their onset. Only timely diagnosis and qualified treatment contribute to the achievement of positive results.

Diagnostics

In the diagnosis of hyperandrogenism, both complaints, anamnesis and data on the objective status of the patient, as well as laboratory and instrumental research methods, are important. That is, after evaluating the symptoms and history data, it is necessary not only to identify the fact of an increase in the level of testosterone and other male sex hormones in the blood, but also to detect their source - a neoplasm, polycystic ovary syndrome or other pathology.

Sex hormones are examined on the 5th-7th day of the menstrual cycle. The blood levels of total testosterone, SHBG, DHEA, follicle-stimulating, luteinizing hormones, as well as 17-hydroxyprogesterone are determined.

To find the source of the problem, an ultrasound of the pelvic organs is performed (if ovarian pathology is suspected, using a transvaginal sensor) or, if possible, magnetic resonance imaging of this area.

In order to diagnose a tumor of the adrenal glands, the patient is prescribed computed tomography, magnetic resonance imaging or scintigraphy with radioactive iodine. It should be noted that small tumors (less than 1 cm in diameter) in many cases cannot be diagnosed.

If the results of the above studies are negative, the patient may be prescribed a catheterization of the veins that carry blood away from the adrenal glands and ovaries in order to determine the level of androgens in the blood flowing directly from these organs.

Treatment of hyperandrogenism in women

The main method of treating hyperandrogenism in women is taking estrogen-progestin oral contraceptives with an antiandrogenic effect, for example, Diana 35. The drugs slow down the synthesis of gonadotropins, suppress the secretion of ovarian hormones and normalize the menstrual cycle. Sometimes they also get by with gestagenic agents, such as Utrozhestan.

Other principles of treatment:

• If oral contraceptives are contraindicated for a woman, then they are replaced with Spironolactone or Veroshpiron. They are used in severe premenstrual syndrome and polycystic ovaries to block the intracellular dihydrotestosterone receptor and suppress testosterone synthesis.
• Androgenization in women with adrenogenital syndrome is treated with glucocorticoids such as Dexamethasone and Prednisolone.
• In the case of hypothyroidism or a high level of prolactin, the concentration of these substances is directly corrected. The amount of androgens in this case normalizes itself.
• With hyperinsulism and obesity, they take the hypoglycemic drug Metformin, follow a diet and play sports.
• Benign neoplasms of the ovaries or adrenal glands are an indication for surgical intervention.
• To normalize the menstrual cycle, Duphaston is often used. It is taken even after pregnancy to reduce the risk of miscarriage.
• Renin-angiotensin blockers (Valsartan) help to eliminate arterial hypertension. ACE inhibitors(Ramipril, Perindopril).

The form of hyperandrogenism also affects the treatment regimen. The patient may need help with hirsutism, reproductive dysfunction, or complete infertility. The goal of treatment in pregnant women, if there is a threat of miscarriage, is to maintain pregnancy.

Prevention

Hyperandrogenism has no specific preventive measures.

The main ones include compliance with the regime proper nutrition 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, you should not get involved in sports, which also (especially when taking steroid drugs) can lead to hyperandrogenism.

Rehabilitation is required for patients with hyperandrogenism of tumor origin, 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.

Hyperandrogenism is a pathological endocrinological condition, which is manifested by an increase in the concentration of androgens in the blood. These include testosterone, dihydrotestosterone, androstenediol, androstenedione, and dehydroepiandrostenedione. In a woman's body, androgens are produced in the ovaries and adrenal glands. The disease is manifested primarily by external changes in the body and dysfunction of the genital organs (endocrinological infertility).

The norm of androgens in women depends on age and physiological state, so the concentration of testosterone should be within the following limits:

• 20-50 years old - 0.31-3.78;
• 50-55 years old - 0.42-4.51;
• during pregnancy - the indicator is increased by 3-4 times.

Index of free androgens, the norm in women

Free androgens are a fraction of hormones that perform an active biological function in the body. These include free and loosely bound testosterone. The free androgen index (ISA) is the ratio of total testosterone to its biologically active fraction. The rate of this indicator depends on the phase of the menstrual cycle:

• follicular phase - 0.9-9.4%;
• ovulation - 1.4-17%;
• luteal phase - 1-11%;
• during menopause - no more than 7%.

Hyperandrogenism syndrome in women and men

On the forums, hyperandrogenism is often described as a disease that appeared from nowhere and its causes are unknown. This is not entirely true. Despite the reviews, hyperandrogenism is a well-studied disease.

An elevated androgen level is not always a sign of the development of the disease. The physiological concentration of hormones differs in different periods of development and life of the female body. During pregnancy, hyperandrogenism is a factor that is necessary for the normal development of the fetus. Also in the older period, the highest overall indicators of these biologically active substances are observed, which is due to the restructuring of the body in menopause. In such cases, the norm is considered the option when increased content hormones does not bring discomfort to the patient.

Forms of hyperandrogenism

There are various forms of the diagnosis of hyperandrogenism. Primary hyperandrogenism is congenital and is caused by increased production of hormones in the body from early childhood. Secondary - a consequence of a violation of the main mechanism for regulating production - pituitary control, due to diseases of this organ. Congenital mild hyperandrogenism in girls manifests itself from early childhood and often accompanies hereditary pathologies or is a consequence of impaired development of fetal organs during pregnancy. Acquired hyperandrogenism occurs at an older age due to comorbidities, endocrine regulation disorders and exposure to external environmental factors.

The most important, if we consider the pathophysiological aspects, is the classification of hyperandrogenism by changes in the concentration of these hormones. If the patient has a pronounced increase in the amount of testosterone, then we are talking about absolute hyperandrogenism. But there is another clinical variant in which the total concentration of hormones does not increase much, or even remains within the normal range, but all the symptoms are observed that are characteristic of the pathology. In this case, the clinic is caused by an increase in the biologically active proportion of testosterone. This variant is called relative hyperandrogenism.

The breadth of clinical symptoms that occur with hyperandrogenism is due to the fact that testosterone plays a very important role in the regulation of sexual differentiation in the human body. Its biological functions are as follows:

• development of primary and secondary male sexual characteristics;
• a pronounced anabolic effect, which leads to the activation of protein synthesis and the development of muscle mass;
• increased activity of glucose metabolism processes.

In this case, the effects of androgens before and after birth are often distinguished. Therefore, if the patient has this condition during the perinatal period, then her own genital organs remain poorly developed. This condition is called hermaphroditism and usually requires surgical correction in the first years of life.

Biochemical basis of hyperandrogenism

The liver plays an important role in the utilization of the excess part of androgens. In hepatocytes, the process of conjugation of most of the hormones with proteins using specific enzymes takes place. Altered forms of androgens are excreted from the body through bile and urine. A smaller part of testosterone is cleaved through the cytochrome P450 system. Violation of these mechanisms can also lead to an increase in the concentration of androgens in the blood.

Receptors for testosterone and other androgens are present in most body tissues. Since these hormones are steroids, they are able to pass through the cell membrane and interact with specific receptors. The latter trigger a cascade of reactions that lead to the activation of protein synthesis and changes in metabolism.

Changes in the ovaries with hyperandrogenism

One of the main pathophysiological mechanisms of disorders in hyperandrogenism are irreversible changes in the female genital organs. If the syndrome is congenital and hormonal imbalance manifests itself even before the birth of the child, then ovarian atrophy and hypoplasia occur. This automatically leads to a decrease in the production of female sex hormones and a violation of sexual function in the future.

If hyperandrogenism syndrome is acquired at an older age, then the following pathophysiological changes occur in the ovaries:

• the development and proliferation of follicles is inhibited in the early stages (they remain at the initial level of differentiation);
• the follicles are almost fully developed, but the formation of eggs is disrupted, which is why ovulation does not occur;
• the follicles and eggs of a woman develop normally, but the corpus luteum remains defective, which leads to a lack of hormonal levels in the luteal phase of the menstrual cycle.

The clinic for these options is somewhat different from each other, but the most important thing for them is one thing - insufficient ovarian function leads not only to disruption of the normal menstrual cycle, but also to infertility.

ICD code for hyperandrogenism (no photo)

In ICD 10, hyperandrogenism in women with reviews and comments is presented in class E. Endocrinological diseases are collected here. At the same time, depending on the cause and form, in ICD 10, hyperandrogenism in women with reviews has different codes:

E28.1 - if the pathology is caused by isolated ovarian dysfunction (including during menopause and mild hyperandrogenism in girls);

E25.0 - congenital hyperandrogenism, which is caused by a deficiency of the C21-hydroxylase enzyme;

E25.8 - acquired adrenogenital syndrome, including from taking medications;

E25.9 - relative hyperandrogenism ICD 10;

E27.8 - pathologies of the adrenal glands, which lead to increased synthesis of testosterone (including functional hyperandrogenism in men);

E27.0 - hyperfunction of the adrenal cortex (most often with tumors), which leads to hyperandrogenism;

Q56.3 - Congenital clinical hyperandrogenism, ICD code, which leads to the development of female pseudohermaphroditism.

This classification allows you to quite clearly separate the main forms of the disease, and in the future to choose the most effective method therapy.

Hyperandrogenism in women: causes

The causes of hyperandrogenism in women are exclusively hormonal. There is a violation of their production or mechanisms of regulation of the function of the endocrine glands. Therefore, all the causes of hyperandrogenism in women can be divided into three groups:

Congenital defects in enzymes that take part in the metabolism of sterols, which leads to a partial blockade of steroid synthesis and increased testosterone production. Diseases and conditions that are accompanied by hyperplasia of the adrenal cortex. Usually they are manifested by increased secretion of adrenocorticotropic hormone (ACTH), which stimulates the production of androgens. Local dysfunction of the ovaries. At the same time, an isolated increase in the concentration of only androgens is observed, or the ISA index changes, which indicates an increase in their free fraction. Somatic diseases of the liver, which lead to a violation of the mechanisms of excretion of androgens from the body (hepatitis, cirrhosis, cellular cancer, steatohepatosis).

Drugs that are metabolized through the P450 system, which blocks this hormone utilization mechanism.

Adrenal hyperandrogenism. Symptoms of androgenism

The symptoms and treatment of androgenism in women are closely related. An increase in the concentration of androgens in a woman's body affects many systems and organs. The severity of clinical symptoms depends on the concentration of the free fraction of testosterone in the blood. It is she who exhibits biological activity, which leads to numerous signs of hyperandrogenism.

Skin changes in hyperandrogenism

The earliest sign of an increase in testosterone levels is changes in the skin. First of all, in patients it is observed with hyperandrogenism acne - inflammatory process, which develops in the hair follicle sac and sebaceous gland. Most often, these acne appear on the skin of the face, neck, back of the head, back, shoulders and chest. The etiology of this process is bacterial (staphylococcal). At the same time, various polymorphic elements of the rash are observed, the most characteristic of which is a pustule with pus. After a while, it bursts, turning into a crust. Sometimes, bluish scars remain in their place.

The neuroendocrine regulation of the sebaceous glands is also disturbed, which leads to the development of seborrhea.

The nature of the hairline of the skin also changes. Quite often, alopecia is observed - male pattern hair loss, which is accompanied by a significant cosmetic defect. The reverse process is observed on the trunk - the chest, abdomen and back are covered with new hair follicles.

Symptoms of adrenal hyperandrogenism

The main symptoms of hyperadrogenism are called masculinization. These usually include:

• lowering the tone of the voice;
• development of the male type of fat deposition (mainly in the abdominal region);
• the appearance of hairy cover on the face, lips, chin;
• increase in muscle size;
• reduction in the size of the mammary glands.

But the main thing is that ovarian function suffers. Almost all patients present with varying degrees of severity. menstrual function. Cycles become irregular, delays alternate with oligomenorrhea, libido decreases.

There are other symptoms of hyperandrogenism in women, the causes of which are associated with impaired ovarian function. Hyperandrogenism is one of the main causes of hormonal infertility in women. This is caused by cystic deformity, incomplete differentiation of ovarian follicles, inferiority of the corpus luteum and structural changes in the eggs. At the same time, the frequency of development of pathologies of the female genital organs (primarily endometriosis and ovarian cysts) increases. Over time, without effective treatment, the patient begins a period of anovulation.

Also, symptoms of hyperandrogenism in women are often observed, the treatment of which should be immediate in stationary conditions. These include hemorrhages from the genital organs, which sometimes leads to the development of anemia of varying severity.

Signs of hyperandrogenism in women and metabolic disorders

Androgens have a significant impact on the course of metabolic processes in the body. Therefore, with their excess, the following signs of androgen excess in women with hyperandrogenism are observed:

1. Decreased glucose tolerance. Androgens reduce the sensitivity of body cells to insulin, and also activate the processes of gluconeogenesis. This leads to an increased risk of developing diabetes.
2. Enhanced atherogenesis. A number of studies have convincingly shown that hyperandrogenism increases the risk of developing cardiovascular events (heart attacks, strokes). This is due to the fact that an increased concentration of testosterone contributes to an increase in the amount of cholesterol in the blood. This reduces the protective role of female sex hormones.
3. blood pressure due to an imbalance in the main regulatory systems - renin-angiotensin and adrenal.
4. Frequent development of asthenic and depressive conditions. This is due to a serious hormonal imbalance and a woman's psychological response to external body changes.

Symptoms of hyperandrogenism in adolescents

Hyperandrogenism in children and adolescents has several differences. Firstly, if a child had a congenital adrenogenital syndrome, then pseudohermaphroditism is possible. Also, these girls noted an increase in the size of the genital organs - especially the clitoris and labia.

Most often, the symptoms of hyperandrogenism in a child debut with oily seborrhea. It begins with the fact that the fatty glands of the skin (mainly the head and neck) begin to intensively produce their secret. Therefore, the covers of the child become shiny due to their excessive release. Also, blockage of the ducts of the glands often occurs, which contributes to the attachment bacterial infection and the development of local inflammation.

A high concentration of androgens also affects the body constitution of girls. They are characterized by rapid body growth, a set of muscle mass, a significant increase in the circumference of the shoulders. At the same time, the hips remain relatively small.

Symptoms of hyperandrogenism in men

An increase in the concentration of androgens also has a negative effect on the body of men. It mainly occurs with Itsenko-Cushing syndrome, testicular neoplasms, prostate cancer, the use of anabolic drugs for muscle growth and adrenogenital syndrome. In this case, the following symptoms of hyperandrogenism in men are observed:

• early puberty;
• rapid growth during adolescence;
• deformation of the musculoskeletal system;
• early appearance of secondary sexual characteristics;
• hypersexuality;
• disproportionate size of the genitals;
• early baldness;
• emotional lability, tendency to aggressiveness;
• acne.

Physiological hyperandrogenism in men is physiological during adolescence, but by the age of 20, testosterone levels decline, indicating the completion of puberty.

Diagnosis of hyperandrogenism

It is very important to consult a doctor in a timely manner if there is a suspicion of hyperandrogenism. Running for tests on your own is not very effective, since not everyone knows which hormones to take in a woman with hyperandrogenism.

Diagnosis of hyperandrogenism in women begins with anamnesis. The doctor needs to find out the chronology of the onset of symptoms and the dynamics of their development. Also be sure to ask about the presence of this pathology in the immediate family of the patient and about all past diseases. This is followed by a thorough inspection. Pay attention to the presence of secondary sexual characteristics, the degree of their severity, the condition of the scalp, the purity of the skin, the type of constitution, the level of development of muscle mass, possible changes in other organs.

Particular attention is paid to the full functioning of the reproductive system. They collect information about the regularity of menstruation, the presence of any deviations in their course, if necessary, the gynecologist makes an examination. In addition, the doctor needs to know what medications the patient has taken during last year. If a genetic pathology is suspected, a consultation with a geneticist is mandatory.

Laboratory diagnosis of hyperandrogenism in women

The next step in diagnosing hyperandrogenism is to conduct a set of laboratory tests that provide information about functional state organism as a whole and endocrine system. Patients are prescribed routine examinations - general analysis blood, urine, basic biochemical parameters (creatinine, urea, blood sugar, liver enzymes, bilirubin, lipid profile, total protein and its fractions, indicators of the blood coagulation system). Particular attention is paid to the concentration of glucose, therefore, with its increase, a study of glucosylated hemoglobin and the glycemic profile is also carried out.

The next step is an analysis for hyperandrogenic hormones:

• Total blood testosterone and free androgen index (ISA).
• The main hormones of the adrenal glands are cortisol and aldosterone.
• Female sex hormones - estrogendiol, 17-OH-progesterone, luteinizing and adrenocorticotropic hormone (ACTH).
• If necessary, small and large dexamethasone tests are also carried out, which make it possible to distinguish between the pathologies of the adrenal glands and the pituitary gland.

The study of hormone concentrations allows you to establish at what level there was a violation of endocrine regulation. If you suspect hyperandrogenism, you can take tests at specialized endocrinological centers or private laboratories.

If necessary, genetic research is also carried out: sampling of biological material with a further search for defective genes.

Instrumental diagnosis of hyperandrogenism

results laboratory diagnostics allow you to establish a diagnosis of hyperandrogenism syndrome, but do not give additional information about possible reason. Therefore, patients also need to undergo a series of instrumental studies to confirm or turn off the pathologies that provoked the symptoms of the disease.

Examination for hyperandrogenism includes ultrasound diagnostics abdominal organs, kidneys, adrenal glands, uterus and ovaries. This simple and accessible method provides key information about the state of these organs.

To turn off benign and malignant neoplasms, computed tomography (CT) of the pituitary, hypothalamus and adrenal glands is performed. If suspicious tissue hyperplasia is detected, it is also necessary to conduct a biopsy of the organ, followed by a cytological analysis, during which morphological features fabrics. Based on these results, a decision is made on a surgical or conservative treatment method.

For indications, additional monitoring of the main functional systems of the body is carried out. For this purpose, an ECG is taken, an X-ray of the chest organs is prescribed, the patient is sent for an ultrasound examination of the heart and large arteries, and rheovasography.

Treatment

Causes, symptoms, treatment of hyperandrogenism in women are closely related. Modern therapy for hyperandrogenism combines hormonal drugs that allow you to normalize the endocrinological background in the body, surgical interventions aimed at correcting external signs of masculinization, as well as changing your lifestyle, which helps improve self-esteem, reduce the risk of complications and the development of other pathologies. A separate aspect is the psychological support of patients, which allows them to better adapt to the disease and continue a full life.

General therapy measures

Treatment of hyperandrogenism in women begins with a lifestyle change. In conditions of metabolic changes, patients are prone to gaining excess weight. Therefore, all patients with hyperandrogenism are advised to regularly do moderate exercise or play their favorite sport. It is also very helpful to give up your bad habits- Abuse of alcohol and smoking, which significantly reduces the risk of developing pathologies of the cardiovascular system.

Since with hyperandrogenism there is an increase in the concentration of glucose in the blood due to impaired insulin tolerance of tissues, the aspect of a healthy diet is very important. Therefore, doctors often consult with nutritionists to select the optimal diet for the patient.

Drug therapy for hyperandrogenism

How to treat hyperandrogenism with medication? Target drug therapy– correction of hormonal imbalance in the body. Therefore, the drugs that are used for treatment are selected based on laboratory data. The peculiarity of therapy is that in most cases it is long-term and can last the entire life of the patient. The doctor should convincingly explain that refusing to take medication after the first improvement in the condition is guaranteed to lead to a recurrence of the hyperandrogenism syndrome.

Progesterones and estrogens in hyperandrogenism

Clinical guidelines for hyperandrogenism advise prescribing replacement therapy. The most commonly used hormonal preparations (long protocol IVF), which contain estrogen and progesterone. They are produced in the form of creams, patches, tablets and capsules. Transdermal application has one significant advantage - the drug molecules are not metabolized in the liver, which reduces their toxic effect. However, in oral forms, the bioavailability index is much higher, which allows you to quickly raise the level of the hormone in the blood to the required indicator.

Among estrogen preparations, Proginova, Estrogel, Menostar, Estramon are most often prescribed. With progesterone medications- Utrozhestan, Ginprogest, Proginorm, Prolutex. However, these drugs should not be used in severe liver dysfunction, hormone-sensitive tumors, porphyria, high risk of hemorrhage, and recent hemorrhagic strokes.

Antiandrogens

Antiandrogens are synthetic nonsteroidal testosterone antagonists. Most drugs are able to bind hormone receptors, and thus prevent the occurrence of their biological effects. Most often used for the prevention of development further development hormone-sensitive tumors, but also for long-term therapy in hyperandrogenism.

The main drug of this drug group is Flutamide. However, it is forbidden to prescribe it for chronic liver pathologies with serious violations of its function. Also, you can not use the drug in childhood due to possible side effects.

Glucocorticoids

Active use was also found by "Metipred" for hyperandrogenism and "Prednisolone" - steroid glucorticoids. They are prescribed in the presence of symptoms of adrenal insufficiency, which is sometimes observed in this pathology. However, it should be borne in mind that these drugs can lead to numerous side effects (hypercorticism). "Dexamethasone" in hyperandrogenism is often the drug of initial therapy, especially in the adrenal form of the disease.

Mineralocorticoid antagonists

With adrenogenital syndrome, as well as with some other forms of congenital hyperandrogenism, there is an increase in aldosterone secretion, which is accompanied by an increase in blood pressure and electrolyte imbalances in the body. In such cases, synthetic antagonists of these receptors are prescribed - "Eplerenone", "Spironolactone", "Veroshpiron" for hyperandrogenism, reviews of the effectiveness of which are positive.

Symptomatic therapy of comorbidities

Of particular importance is hypoglycemic therapy, since many patients experience an increase in the concentration of glucose in the blood. If diet and lifestyle changes are not enough for them, then the following groups of medicines are prescribed:

• biguanides ("Metformin", "Diaformin");
• sulfonylurea preparations ("Diabeton", "Amaryl");
• thiazolidinediones ("Pioglitazone", "Rosiglitazone");
• alpha-glucosidase inhibitors ("Acarbose").

With the development of arterial hypertension, ACE inhibitors (Perindopril, Ramipril, Enalapril) and renin-angiotensin blockers (Valsartan) are mainly used. In the presence of hepatic pathology, hepatoprotectors are prescribed to reduce the load on this organ. Reviews about the treatment of hyperandrogenism with properly selected symptomatic therapy are extremely positive.

The Importance of Psychological Help

Clinical recommendations for the treatment of adrenal hyperandrogenism in developed countries necessarily include a clause on the timely provision of psychological assistance to patients. Therefore, leading clinics prescribe individual or group psychotherapy sessions for patients. This is due to the fact that external changes in the body, hormonal imbalance and infertility increase the risk of developing depression. The patient's unwillingness to fight her disease also negatively affects the success of other treatments. Therefore, it is necessary to provide all possible support and sympathy not only from the medical staff, but also from relatives and relatives. This, according to reviews of the treatment of hyperandrogenism in women, is the most important component of successful therapy.

Treatment of hyperandrogenism with folk remedies

Treatment of folk methods of hyperandrogenism in women, is it real?

Hyperadrogenism is accompanied by a serious violation of the hormonal balance in the body. Unfortunately, the treatment of folk methods of hyperandrogenism is not able to effectively reduce the level of testosterone in the blood. They can only be used for the purpose of prevention and reduction unwanted effects androgens. No herbal treatment for hyperandrogenism will replace hormone therapy.

Unfortunately, many patients spend a lot of time on the alternative treatment of hyperandrogenism, and go to the doctor at the moment when there have been serious changes in their body.

The role of diet in the treatment of hyperandrogenism in women

Diet plays the most important role in hyperandrogenism. It is prescribed to all patients to reduce the risk of developing metabolic disorders. The diet for hyperandrogenism in women is low-calorie with a reduced carbohydrate content. This helps to reduce the increase in glucose. At the same time, preference is given to foods that contain a lot of fiber (mainly fruits and vegetables).

When compiling a diet, not only the severity of hyperglycemia and other metabolic disorders is taken into account, but also the current weight of the patient. A dietitian calculates the body's basic need for energy and individual nutrients. It is also important to evenly distribute the required amount of food throughout the day to avoid a sudden load. To this end, the entire diet for hyperandrogenism is divided into 5-6 meals. It is also necessary to take into account the physical activity of the patient. If she plays sports or has a great load during the day, then this should be compensated by a sufficient amount of energy reserves that come with food.

Patient self-control is important. She must learn to independently monitor her own diet and know which foods and dishes she can and cannot. This contributes to the maximum positive effect of the diet.

Prohibited and permitted foods for a diet in women

First of all, products that are made on the basis of flour are turned off from the diet. Seriously limit the use of white bread (especially fresh pastries), muffins, buns, cookies (except diabetic ones), cakes and sweets. It is also necessary to reduce the amount of canned food (meat or fish), smoked products, fatty meats. Potatoes and any dishes with a high content of it are turned off from vegetables.

Also, patients are forbidden foods high in fat. Their danger to the body is that they are actively oxidized into ketone bodies, which are a serious danger to the central nervous system. Normally, the body must cope with the regulation of this process and the utilization of fats, however, in conditions of metabolic disturbances, this becomes too difficult a task for it.

From cereals, patients are advised to give preference to buckwheat. At the same time, it can be used as an ingredient in other dishes, as well as cooked in milk or water. Buckwheat is a unique product that minimally affects the metabolism of carbohydrates. Therefore, it is included in all diets compiled by professional nutritionists. From cereals, you can also use corn, pearl barley and oatmeal. However, their number must be carefully controlled.

Dairy products are also not allowed to be consumed by everyone. It is necessary to refrain from homemade milk, sour cream, butter, mayonnaise, yoghurts and kefirs with a high fat content.

The role of fruits in the diet for hyperandrogenism

Fruits, as high-fiber foods, play a key role in the diet of patients with hyperandrogenism. They are not only a source of many vitamins, but also potassium, which is extremely important for the correct functioning of the cardiovascular system. They also normalize the function digestive system, improving the processes of motility and absorption of nutrients.

Almost all known fruits do not contain pure glucose or starch, they accumulate carbohydrates in the form of fructose and sucrose. This allows these products to have virtually no negative effect on the body.

However, not all products are equally useful. Therefore, patients with hyperandrogenism should exclude bananas, grapes, dates, figs and strawberries from their diet. Other fruits can be consumed without restrictions.

Hyperandrogenism of the ovaries of genesis

Hyperandrogenism of ovarian genesis is the most common form increase in the concentration of androgens in the blood in women. It occurs as a result of congenital or acquired pathologies of the ovaries, a key organ of endocrine secretion.

Polycystic ovary syndrome (PCOS)

The main disease that leads to hyperandrogenism is polycystic ovaries. According to statistics, it is observed up to 20% of women of reproductive age. However, PCOS ovarian hyperandrogenism is not always clinically manifested. The pathogenesis of this pathology is associated with a decrease in the sensitivity of peripheral tissues to insulin, which leads to its hypersecretion in the pancreas and hyperstimulation of specific receptors in the ovaries. As a result, the secretion of androgens and estrogens increases, although there is also the option of an isolated increase in the concentration of testosterone (in the presence of a deficiency of certain enzymes in the tissues of the gland).

Hyperandrogenism of the ovarian genesis of PCOS, in addition to menstrual disorders and masculinization symptoms, is also accompanied by central obesity, the appearance of pigmentation spots on the skin, chronic pain in the lower abdomen and the development of concomitant pathologies of the female reproductive system. At the same time, changes in the blood coagulation system are also observed, which increases the risk of blood clots in peripheral vessels, especially against the background of chronic inflammation.

The method of therapy is predominantly conservative, especially in young patients.

Neoplasms of the ovaries

The second reason, which often causes mild hyperandrogenism of ovarian genesis, is the development of hormonally active ovarian neoplasms. In this case, there is a huge uncontrolled production of androgens. Clinical symptoms appear suddenly, and actively progress over a short period of time.

Such a hormonally active variant of tumors is quite rare. in the best way its imaging is ultrasound and CT scan. The detection of this neoplasm also requires a biopsy with cytological analysis, as well as a thorough screening of the whole body. Based on these results, a decision is made on the further tactics of managing the patient. Usually the treatment of this pathology is carried out in a specialized hospital.

Adrenal hyperandrogenism

Adrenal hyperandrogenism in women is most often an acquired disease. It occurs due to hyperplasia or development benign tumor bark of the gland. These two conditions lead to increased production of hormones, not only androgens, but also other forms of steroid hormones.

The clinical picture tends to gradually increase. Most often it is detected in patients older than 40 years. Sometimes the clinic is supplemented painful sensations in the area of ​​the lower back. It is also accompanied by fluctuations in blood pressure.

Treatment of tumors of the adrenal glands is carried out in specialized hospitals. Be sure the patient is sent for a biopsy of the neoplasm with its cytological analysis in order to exclude a malignant process. Mostly, the tumor is removed at once with the adrenal gland, and then lifelong hormone therapy is prescribed.

Congenital form of adrenal hyperandrogenism

The congenital form of adrenal hyperandrogenism usually manifests itself already in early childhood. The cause of the pathology is a deficiency of the enzyme C21-hydroxylase, which plays a key role in the processes of chemical transformations of steroid hormones. Deficiency of this compound leads to increased production of androgens.

This form of adrenal hyperandrogenism is hereditary. The defective gene is localized in the 6th pair of human chromosomes. In this case, the disease is recessive, therefore, for its clinical manifestation, it is necessary that both parents of the child be carriers of this anomaly.

There are also several forms of adrenal hyperandrogenism syndrome. In the classical variant, pronounced signs of adrenogenital syndrome with hirsutism, masculinization, pseudohermaphroditism, and metabolic disorders are observed. The debut of this form usually falls at the beginning of adolescence, when it is predominantly diagnosed.

The post-pubertal form of adrenogenital syndrome is detected by chance. Usually, the level of androgens in patients with it is not high enough for the development of masculinization. However, they often experience abortions in the early stages, which is usually the reason for going to the doctor.

Mixed hyperandrogenism

Hyperandrogenism of mixed origin is due to impaired testosterone production in both the ovaries and adrenal glands. It occurs due to a congenital deficiency of the enzyme 3-beta-hydroxysteroid dehydrogenase, which takes part in the metabolism of steroid hormones. Therefore, there is an increased accumulation of dehydroepiandrosterone, a weak precursor of testosterone.

Increased production of this hormone leads to the development of a typical picture of hirsutism and masculinization. The first symptoms usually appear during adolescence.

At the same time, mixed hyperandrogenism is accompanied by increased production of precursors and other steroid hormones - gluco- and mineralocorticoids. Therefore, there are significant metabolic changes in the type of Itsenko-Cushing syndrome, symptomatic arterial hypertension and electrolyte imbalance.

Therapy of mixed hyperandrogenism is exclusively conservative. Patients are prescribed dexamethasone, oral contraceptives, and aldosterone antagonists to normalize hormonal levels. In this case, the treatment can be lifelong.

Hyperandrogenism and pregnancy

Hyperandrogenism and pregnancy are often incompatible conditions. As you know, during this disease (regardless of the initial cause) there are serious violations of the endocrine and reproductive systems of women. The key symptom is the irregularity or absence of menstruation, and there is also an inferiority in the maturation and development of germ cells in the ovaries. These two factors provoke hormonal infertility in the patient. The situation is aggravated by the fact that often there are no symptoms of hirsutism and masculinization, so women do not even suspect that they have this pathology.

Is it possible to get pregnant with hyperandrogenism? This is possible if the hormonal imbalance has occurred recently or the necessary replacement therapy. Therefore, the following question arises - how to properly manage such a patient, and what complications are possible during pregnancy for her and the fetus.

Pregnancy problems with hyperandrogenism

Behind the data of numerous studies, there are dangerous weeks of pregnancy with hyperandrogenism. The greatest number of spontaneous abortions was recorded in the first trimester, when about 60% of all observed pregnancies ended in this way. The reason for this situation is that the imbalance of hormones affects the development of the endometrium of the uterus and the defective formation of the placenta, due to which the fetus acquires an insufficient amount of nutrients and blood for its own growth.

The second critical period occurs at 12-14 weeks. It is then that the formation of the key systems of the child's body is completed. And if he has serious disorders that make him not viable in the future, the mother's body itself provokes a miscarriage.

Isthmic-cervical insufficiency

In women during pregnancy, hyperandrogenism in the second or third trimester provokes the development of isthmic-cervical insufficiency. In this condition, there is a decrease in tone smooth muscles the cervix, which leads to its increase in the lumen and the appearance of a permanent passable canal with the vagina.

The danger of isthmic-cervical insufficiency is that the risk of premature birth increases, since the muscle mass of the uterus becomes unable to hold the fetus. If the patient has a chronic infection of the external genital organs or the excretory system, there is also the possibility of developing a bacterial, fungal or viral process in the uterus or placenta.

The first signs of this condition usually appear after the 16th week of gestation, when the fetal adrenal glands begin to function, which leads to an increase in the level of steroid hormones (and androgens). It is very important for patients in this period to be observed by their gynecologist, since the symptoms of isthmic-cervical insufficiency in most cases are absent. And the only way to identify this pathology is a gynecological examination.

Management of pregnancy with hyperandrogenism

Forums often give false information about pregnancy hyperandrogenism, especially when it comes to folk recipes or herbs. Therefore, you need to focus only on a qualified gynecologist.

Since hyperandrogenism and pregnancy often go together, it is worth starting treatment in advance. All patients with suspected this condition should be carefully examined (especially attention is paid to the concentration of hormones in the blood).

Drug therapy should last the entire period of pregnancy. It includes carefully selected doses of dexomethasone, which, by a feedback mechanism, should inhibit the synthesis of androgens in the adrenal glands. If necessary, progesterones or estrogens are also prescribed to fully correct the hormonal balance. Androgen antagonists during pregnancy are strictly prohibited because they have a toxic effect on the fetus.

Also, hyperandrogenism during pregnancy requires constant monitoring by doctors. Therefore, in the second or third trimester, many patients are advised to go to a specialized department.

Isthmic-cervical insufficiency requires surgical intervention. Pregnant women undergo a low-traumatic operation with a suture on the cervix. This manipulation allows you to completely eliminate the threat of miscarriage or infection of the uterine cavity.

Hyperandrogenism in teenagers

Hyperandrogenism in adolescents often makes its debut unexpectedly. This period of the body's life is accompanied by serious hormonal changes, changes in the functioning of many endocrine glands. And if a child has a congenital deficiency of certain adrenal or ovarian enzymes, then there is a violation of the metabolism of steroids and increased production of androgens.

Hyperandrogenism in adolescent girls often begins with symptoms of body restructuring. They have broad shoulders, while the circumference of the hips practically does not increase. At the same time, muscle mass increases. The hairline begins to grow behind the male type. Patients have skin problems - almost everyone has oily seborrhea and acne. Violations of the reproductive system also join (delay in the first menstruation and its further irregularity).

It is especially important to detect such changes as quickly as possible, when it is possible to neutralize all the symptoms of hyperandrogenism with the help of hormone therapy. In addition, such patients often suffer from depression because of their appearance, so psychological support is especially important for them.

When it comes to a disease such as hyperandrogenism in women, the causes of symptoms, treatment and preventive measures are always associated with such a problem as the effect of androgens on the body. This process leads to the appearance of masculine features in the female appearance and other not very pleasant changes. In more detail, we are talking about such manifestations as the appearance of vegetation on the face and body, a low voice, as well as changes in some elements of the figure.

It is worth noting the fact that this pathology of the female endocrine system is common, and can not only lead to unpleasant external changes, but also cause infertility. Therefore, when the first symptoms of hyperandrogenism appear, you should immediately plan a visit to the doctor.

Why does pathology develop

The topic “hyperandrogenism in women: causes, symptoms, treatment” is very important for the fairer sex, since this problem manifests itself in approximately 20% of patients. Therefore, it makes sense to pay attention to those factors and processes that lead to the development of this disease.

As the main cause, AGS can be identified - adrenogenital syndrome. The bottom line is that the adrenal glands are capable of producing many other hormones besides androgens, such as glucocorticoids. The latter appear under the influence of a certain enzyme. The basis for their occurrence are the accumulated androgens. Sometimes women already have an enzyme defect at birth, as a result of which male hormones are not converted, but accumulate on an ongoing basis, causing unpleasant changes in the female body.

There is another process due to which hyperandrogenism of adrenal origin develops. We are talking about tumors of the adrenal glands. They are also formed against the background of an increase in the concentration of androgens.

The risk of developing the pathology mentioned above also appears in the case when the production of male hormones in the ovaries of a woman occurs. Moreover, cells that produce androgens can cause tumors to form in the ovarian region.

Hyperandrogenism syndrome is sometimes the result of exposure to pathologies of other endocrine organs, such as the pituitary gland.

Signs of androgen excess

If we talk about the clinical symptoms of an increased concentration of the male hormone, then they can be described as follows:

• acne;
• hair loss and bald patches in the forehead (androgenetic alopecia);

• the sebaceous glands begin to produce an excessive amount of secretion, as a result of which the fat content of the skin increases;
• baryphony, which means lowering the timbre of the voice;
• hair appears on the abdomen and chest.

It is worth noting the fact that hirsutism - excessive growth of terminal hair on the female body, is diagnosed in 80% of patients with such a problem as hyperandrogenism syndrome.

With a similar disease, some representatives of the weaker sex may have a menstrual cycle disorder, a complete absence of menstruation, as well as myocardial hypertrophy, obesity, infertility and hypertension.

The concentration of male hormones can cause an increase in the susceptibility of the female body to infections of various types. Fatigue and a tendency to depression are also possible.

Acne and sebaceous glands

To clearly understand what to do with such a problem as hyperandrogenism in women, the causes, symptoms, treatment and diagnosis should be considered thoroughly. Since the factors that cause the development of the disease were discussed above, it makes sense to study the features of the symptoms.

If we touch on such a problem as acne, it is worth noting that they are the result of keratinization of the walls of the follicle and increased production of sebum, which is stimulated by the concentration of androgens, including in plasma. With such symptoms, as a rule, COCs or antiandrogens are prescribed, which can significantly improve the patient's condition.

Also, under the influence of male hormones in androgen-dependent zones, pigmented, thick, coarse hair appears instead of vellus. This usually happens during puberty. At the same time, the effect of androgen on the region of the eyebrows, eyelashes, temporal and occipital parts remains minimal.

Adrenal hyperandrogenism

It is worth recalling that the adrenal glands are two endocrine glands that are located directly above the kidneys themselves.

They are the source of 95% of the produced androgen (DEA-sulfate). The complexity of hyperandrogenism associated with these glands comes down to the fact that the pathology is congenital and makes itself felt against the background of androgenital syndrome. It leads to a critical decrease in the level of enzymes in the female body that are necessary for the production of hormones such as glucocorticoids.

Hyperandrogenism of adrenal genesis is due to this deficiency, which leads to an increase in the concentration of other hormones - pregnenolone, progesterone, etc. Such changes result in increased production of androgen in the female body.

Sometimes a pathology is diagnosed that was caused by tumors of the adrenal glands that secrete the male hormone. According to statistics, such a form of the disease as adrenal hyperandrogenism is recorded in 30-50% of women who have problems with androgen.

Impact on the ovaries

A high concentration of male hormones can also affect the functioning of the ovaries. In most cases, this problem makes itself felt through two forms: hyperthecosis and polycystic. It is important to pay attention to the fact that the risk of developing this pathology in women increases with regular strength sports.

Ovarian hyperandrogenism is a consequence of slowing down the growth of follicles under the influence of androgens. Since the ovaries consist of them, the result of such processes is the overgrowth of the latter. The medical name for this problem is follicular atresia.

But these are not all the difficulties that accompany ovarian hyperandrogenism of genesis. The bottom line is that the male hormone plays the role of a factor against which the pathological formation of fibrous tissue develops. connective tissue leading to polycystic. In this situation, the good news is the fact that only 5% of women face such a problem.

It is also worth noting that this form of hyperandrogenism in the fairer sex is the cause of the failure of the central regulation of androgen levels. This process occurs at the level of the hypothalamus and pituitary gland. As a result, the hormonal background changes significantly.

Signs to look out for

There are a number of symptoms that indicate the appearance of the problem described above. The fact that there is such a pathology as ovarian hyperandrogenism of genesis can be found in the following manifestations:

• osteoporosis;
• seborrhea;
• on the face, in addition to acne, peeling and inflammation appear, which are difficult to neutralize with the usual cosmetic methods;
• amyotrophy;
• excess weight;
• change in proportions female body- masculinization;
• coarsening of the voice (baryphony);
• hair growth all over the body, even on the face;
• the formation of bald patches on the head.

In addition, there are many more secondary symptoms, such as increased blood glucose levels, arterial hypertension, decreased immunity, etc.

Excess weight

Obesity in women can be caused by the ovarian hyperandrogenism described above. With this form of pathology, an increase in the level of estradiol is often recorded.

Doctors conducted a study, according to which the following information was confirmed: both the high level of the male hormone and the estrogens that form under its influence have the most direct effect on the development of obesity corresponding to the male type.

Such processes are the cause of an increase in insulin dependence and a subsequent increase in the concentration of the male hormone in the body of women suffering from the pathology described above. In some cases, androgens do not affect a woman's weight through the central nervous system.

mixed form

Doctors with a certain frequency have to deal with the manifestation of several forms of hyperandrogenism. This situation is explained by the fact that at the same time there is a violation of the functions of the adrenal glands and ovaries.

The possibility of such a complication is important to consider when studying the dangers of hyperandrogenism in women. In essence, this is what happens: adrenal androgens, concentrating in the adrenal glands, thereby increase the level of the male hormone in the ovaries. This process also occurs in the blood, which leads to increased production of luteinizing hormone. The latter, in turn, provokes the appearance of hyperandrogenic syndrome.

The occurrence of a mixed form of pathology may be due to severe injuries, brain intoxication, or a pituitary tumor.

Diagnostics

Initially, the doctor must separate hyperandrogenism from other diseases against which it develops (acromegaly, Cushing's syndrome, liver disease, etc.). The next step is to determine the hormonal level. This procedure should be carried out on an empty stomach in the morning. A similar analysis must be performed three times, since the hormonal background at a high concentration of androgen is constantly changing.

Attention is drawn to the level of dehydroepiandrosterone, a high content of which will indicate adrenal hyperandrogenism. The level of ketosteroids in the urine is also important. If its content goes beyond the norm, then it makes sense to suspect the development of pathology.

Treatment Methods

Hyperandrogenism is too serious a problem to ignore the help of qualified doctors. And if we analyze the entire course of treatment, we can conclude that it is aimed at achieving 4 key goals:

• elimination of manifestations on the skin;
• normalization of the menstrual cycle;
• treatment of infertility that was caused by anovulation;
• elimination and prevention of metabolic disorders associated with the underlying disease.

A diet for hyperandrogenism in women is prescribed in case of a significant increase in weight. In this case, it is important to strictly adhere to all the recommendations of the doctor, only if this condition is observed, you can get the desired result.

Those patients who intend to have a child, in most cases, are prescribed hormone therapy that can ensure full ovulation.

Women who do not plan to become pregnant are treated with oral contraceptives and, in some cases, wedge ovarian excision.

Drugs for the treatment of hyperandrogenism in women are also actively used if the body is not able to neutralize the high level of androgen on its own. We are talking about such means as "Metipred", "Dexamethasone", etc. Surgical intervention can be prescribed if the pathology is provoked by a tumor.

Results

The high concentration of the male hormone in the female body is more than a serious problem that often develops against the background of at least dangerous diseases. Therefore, when the first symptoms appear, diagnosis and treatment must be carried out without fail.

Varieties and causes of the syndrome

The process of maturation of androgens occurs in the ovaries and adrenal glands. Normal quantity of the produced hormone and its correct ratio with estrogens provides the hormonal balance necessary for the full functioning of the body.

Depending on the origin of the pathology, several of its forms are distinguished:

• • Hyperandrogenism of ovarian origin - occurs with polycystic ovary syndrome. The reason is a malfunction of the hypothalamus-pituitary gland system. The disorder is hereditary.
  • Hyperandrogenism of adrenal origin is caused by a malfunction of the adrenal cortex. The disease is congenital in nature, and can also be caused by tumors (Itsenko-Cushing's disease). In this case, the first menstruation begins late, with scant discharge, and over time it may stop altogether. Other characteristic features are the abundance of acne in the back and chest, underdevelopment of the mammary glands, the formation of a figure according to the male type, an increase in the clitoris.

A number of patients are diagnosed with hyperandrogenism of mixed origin. In this case, the functioning of the ovaries and adrenal glands is simultaneously disrupted in the body. This pathology is caused by hypothalamic and neuroendocrine disorders. Disruptions in hormonal balance are exacerbated by vegetative-neurotic disorders. In some cases, mild hyperandrogenism is diagnosed, in which androgen levels are normal, and ultrasound does not detect the presence of tumors in the internal organs.

The mixed form prevents the onset of pregnancy and makes it impossible to successfully bear a child.

Given the degree of excess of the permissible level of androgens, the absolute and relative forms of adrenogenital syndrome are distinguished. In the first case, the concentration of male hormones exceeds the permissible limits. Relative hyperandrogenism is diagnosed with acceptable levels of male hormones. At the same time, the increased sensitivity of the organs and glands of a woman to their effects is noted.

Summing up, the following main causes of this syndrome can be distinguished:

• • improper production of a special enzyme that synthesizes androgens, resulting in their excessive accumulation in the body;
  • the presence of tumors of the adrenal glands;
  • diseases and malfunctions of the ovaries, provoking excessive production of androgens;
  • thyroid pathology (hypothyroidism), pituitary tumors;
  • long-term use of steroids during professional strength sports;
  • obesity in childhood;
  • 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 sex and thyroid glands, pathology may develop in childhood.

Congenital hyperandrogenism sometimes does not allow to accurately determine the sex of the born child. A girl may have large labia, a clitoris enlarged 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-losing form. The disease is hereditary and usually detected in the first months of a child's life. As a result of the 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.

Clinical manifestations

Symptoms can range from mild (excessive growth of body hair) to severe (development of secondary male sexual characteristics).

The main manifestations of pathological disorders are:

• • acne - occurs with increased oiliness of the skin, which leads to blockage and inflammation of the sebaceous glands;
  • seborrhea of ​​the scalp;
  • hirsutism - the appearance of strong hair growth in places atypical for women (face, chest, abdomen, buttocks);
  • thinning and hair loss on the head, the appearance of bald patches;
  • increased muscle growth, the formation of muscles according to the male type;
  • coarsening of the timbre of the voice;
  • violation of the menstrual cycle, the scarcity of discharge, sometimes the complete cessation of menstruation;
  • increased sex drive.

Occurring failures in the hormonal balance cause the development of diabetes mellitus, the appearance of excess weight, lipid metabolism disorders. Women become very susceptible to various infectious diseases. They often develop depression, chronic fatigue, increased irritability and general weakness.

One of the most severe consequences of hyperandrogenism is virilization or virilization syndrome. This is the name of the pathology of the development of the female body, in which it acquires pronounced male characteristics. Virilization is a rare abnormality, it is diagnosed in only one patient out of 100 who have excessive growth of body hair.

A woman develops a male figure with increased muscle growth, menstruation completely stops, and the size of the clitoris increases significantly. Very often, these signs develop in women who take steroids uncontrollably to increase endurance and physical strength when playing sports.

Establishing diagnosis

Diagnosis of a pathological condition includes an external and gynecological examination of the patient, an analysis of her complaints about her general well-being. Pay attention to the duration of the menstrual cycle, the localization of excessive hair growth, body mass index, the appearance of the genitals.

What tests should be taken to determine the level of androgens?

Doctors (gynecologist, endocrinologist, geneticist) prescribe the following studies:

• • determination of the level of testosterone, follicular hormone, prolactin, estradiol in the blood and cortisol in the urine;
  • tests with dexamethasone to determine the cause of the syndrome;
  • Ultrasound of the ovaries and adrenal glands;
  • CT scan of the pituitary gland;
  • studies of glucose, insulin, cholesterol levels.

Ultrasound of the pelvic organs will determine the possible presence of polycystic ovaries. Testing is necessary to establish the type of disease.

Materials for research are taken in the morning, before meals. Since the hormonal background is unstable, three samples are taken at intervals of at least half an hour for accurate diagnosis. It is advisable to take tests in the second half of the menstrual cycle, closer to the expected start of menstruation.

Principles of therapy

Treatment of hyperandrogenism should be comprehensive and, first of all, aimed at eliminating problems and diseases that act as provoking factors. The list of such diseases includes pathologies of the thyroid gland, polycystic ovary syndrome, adrenogenital syndrome.

The choice of treatment methods depends on the form of the pathology and the goal pursued by the therapy (combating hirsutism, restoring reproductive function, maintaining pregnancy in the event of a miscarriage).

The main treatment measures include:

• • drug therapy;
  • surgical intervention;
  • the use of traditional medicine;
  • normalization of nutrition and physical activity.

Conservative therapy

It is used to reduce the amount of male hormones produced and to block processes that contribute to their excessive activity. The presence of tumors in the genital organs, causing ovarian hyperandrogenism, is eliminated with the help of surgical intervention.

If a woman is not planning a pregnancy in the near future, but suffers from acne and excessive body hair, oral contraceptives with an antiandrogenic effect are prescribed to get rid of these symptoms (for example, Diana 35).

Such drugs not only eliminate unpleasant external signs, but also contribute to the normalization of the menstrual cycle. For a cosmetic effect, anti-inflammatory ointments are prescribed, which reduce the production of sebum.

In the presence of contraindications to the use of contraceptives, Spironolactone is used for treatment. It is prescribed for severe premenstrual syndrome and for polycystic ovaries. The drug successfully treats acne and excessive hair growth.

The analogue drug is Veroshpiron. His main active substance is also spironolactone. Reception of Veroshpiron is highly undesirable without agreement with the doctor on the duration of use and the required dosage.

If hyperandrogenism is caused by the absence of an enzyme that converts androgens into glucocorticoids, agents are shown that normalize this process. The drug Metipred is very effective. Forms of its release - tablets and powders for injection. The remedy is contraindicated in the presence of infectious and viral diseases, tuberculosis, heart failure. The duration of the course of treatment and dosage is determined by the doctor.

One of the successful methods conservative treatment is a low-calorie diet. It is necessary to get rid of excess weight, which often complicates the course of the disease and brings a woman additional psychological discomfort.

The total number of calories consumed daily should not exceed 2000. In this case, with sufficient physical activity, the number of calories consumed will be lower than those consumed, which will lead to gradual weight loss.

The diet indicated for hyperandrogenism provides for the exclusion from the diet of fatty, salty and spicy foods, as well as alcohol, sauces and fatty gravy.

Compliance with the principles of proper nutrition is supported by regular exercise. Running, aerobics, swimming, active outdoor games are useful.

The fight against hirsutism is carried out using various cosmetic procedures: wax removal, depilation, removal of unwanted hair with a laser.

The use of traditional medicine

Treatment folk remedies It is quite applicable in the complex of drug therapy, but is not a full replacement for traditional methods.

Popular recipes:

1. 1. Herbs of sweet clover, sage, meadowsweet and knotweed are mixed in equal proportions, poured into 200 ml of water, kept in a water bath for 20 minutes and filtered. To the resulting broth, add 1.5 ml of tincture of Rhodiola rosea. Take a decoction of a third cup several times a day before meals.
   2. 2 tablespoons of chopped string, 1 tablespoon of yarrow and motherwort are poured with boiling water, insisted for about an hour, filtered. Take half a glass on an empty stomach in the morning and at bedtime.
   3. A few tablespoons of dry nettle leaves are poured into a glass of water, insisted in a closed vessel, filtered. Take several times a day for a tablespoon.
   4. Rose hips, blackcurrants are poured with boiling water, insisted for about an hour. Then some honey is added. The resulting cocktail is drunk several times a day after meals.

Among the most common folk remedies in the fight against diseases of the gynecological sphere is the upland uterus. It is used in conjunction with other medicinal products in the form of a decoction or tincture.

1. 1. Pour 100 g of boron uterus with 500 ml of vodka and infuse for 2 weeks. Tincture take 0.5 teaspoon three times a day.
   2. Pour 2 tablespoons of boron uterus with a glass of boiling water, leave for about an hour. Drink in small portions throughout the day.
   3. Mix 100 g of green peeled nuts and boron uterus with 800 g of sugar, add the same amount of vodka. Put the bottle with the mixture in a dark place for 14 days. After straining, take a teaspoon half an hour before meals.

Mint is used to reduce the amount of androgens produced. Based on it, tinctures and teas are prepared. For greater effectiveness, milk thistle can be added to mint. Regular intake of green tea normalizes female hormonal balance.

How to treat the problem with medicinal herbs and combine this method with other types of treatment, the attending physician will always prompt. Self-medication is unacceptable!

Hyperandrogenism and infertility

An excess of produced androgens often becomes an obstacle to a desired pregnancy.

How to get pregnant with drug therapy and how realistic is it?

Infertility treatment in this case is aimed at the use of drugs that stimulate the release of an egg from the ovaries. An example of such a drug would be Clomiphene.

One of the most effective drugs used to stimulate ovulation and normalize the menstrual cycle is Duphaston. After the onset of pregnancy, the drug is continued to prevent miscarriage and normalize the development of pregnancy.

If stimulation is ineffective, doctors advise resorting to surgical treatment. modern medicine widely used laparoscopy. During this procedure, the ovaries are excised to help the “exit” of a mature egg. The probability of getting pregnant after laparoscopy is the higher, the less time passes from the day of the operation. The maximum ability to conceive is noted in the first three months.

But even after a successful conception, the presence of hyperandrogenism can prevent the successful bearing of a child. An excess of male hormones often leads to the fact that the fetal egg cannot stay in the uterus. The chance of miscarriage remains high.

Dangerous weeks of pregnancy with hyperandrogenism are the period before the 12th week and after the 19th. In the first case, hormones are produced by the placenta, and after the 19th week they can be produced by the fetus itself.

To maintain pregnancy, the patient is prescribed Dexamethasone (metipred). It helps to lower androgen levels. The dosage of the drug is selected exclusively by the doctor!

Many expectant mothers are very afraid of the side effects of the drug and fear that it can harm the unborn baby. Many years of experience in the use of this drug proves its safety, both for the development of the unborn child, and for the course of the birth itself.

In most cases, to avoid the risk of miscarriage, doctors advise you to first complete the full course of treatment, and only then plan a pregnancy. If a woman is unable to conceive a child, IVF is possible.

Causes

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

• • increased levels of androgens in the blood serum;
  • conversion of androgens to 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 impaired ovarian function. The most common 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, hypothalamus and adrenal glands. The incidence of PCOS among women of childbearing age reaches 5-10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

• • adrenogenital syndrome;
  • congenital adrenal hyperplasia;
  • galactorrhea-amenorrhea syndrome;
  • stromal tecomatosis 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 body hair, and in rare cases, hair loss on the head.

Compensatory hyperproduction of insulin stimulates the production of ovarian cells that produce androgens. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptor cells in the tissues of the ovaries, 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;
  • excess body weight;
  • 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.

Kinds

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

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

• • ovarian, or ovarian;
  • adrenal, or adrenal;
  • mixed - simultaneously there are signs of ovarian and adrenal forms.

Relative hyperandrogenism occurs against the background of the normal content of male hormones with excessive sensitivity of target tissues to sex steroids or enhanced transformation of the latter into metabolically active forms. In a separate category, iatrogenic hyperandrogenic conditions are distinguished, which have developed as a result of prolonged use of hormonal drugs.

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 conditions is characterized by a wide variety of manifestations that fit into the standard set 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 hyperandrogenism of ovarian genesis, which is accompanied by abnormalities in the development of follicles, hyperplasia and uneven exfoliation of the endometrium, and cystic changes in the ovaries. Patients complain of scanty and painful menstruation, irregular or anovulatory cycles, uterine bleeding and premenstrual syndrome. With the syndrome of galactorrhea-amenorrhea, there is a deficiency of progesterone.

Severe metabolic disorders - dyslipoproteinemia, insulin resistance and hypothyroidism are characteristic of the primary pituitary and adrenal forms of hyperandrogenism. Approximately 40% of patients have male-type abdominal obesity 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, breast underdevelopment, a decrease in the timbre of the voice, an increase in muscle mass and body hair are noted; for girls, it is typical later than menarche. 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 activity of dihydrotestosterone. The effect of a hormone that stimulates the secretory activity of the skin glands changes physiochemical properties sebum, causing blockage of the excretory ducts and inflammation of the sebaceous glands. As a result, 70-85% of patients with hyperandrogenism have signs of acne - acne, dilated skin pores and comedones.

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

Less common are other manifestations of androgenetic 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 coarse 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, shins and internal side of the thigh. In postmenopausal women, bitemporal and parietal alopecia are occasionally noted - hair loss at the temples and in the crown area, respectively.

Features of the course of hyperandrogenism in children

In the prepubertal 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 pronounced virilization of the girl and anomalies in the structure of the genitals. With adrenogenital syndrome, there may be signs of false hermaphroditism: clitoral hypertrophy, fusion of the labia majora and vaginal opening, displacement of the urethra to the clitoris, and urethrogenital sinus. At the same time, there are:

• • early overgrowth of fontanelles and epiphyseal fissures in infancy;
  • premature body hair;
  • rapid somatic growth;
  • delayed puberty;
  • Late menarche or no menses.

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 severe adrenogenital syndrome, the development of an adrenal crisis is possible - acute adrenal insufficiency, associated with a threat to life. Parents should be alerted by 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 ovaries. The debut of PCOS often occurs at the stage of formation of menstrual function.

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

Normally, the content of free testosterone in the blood serum of sexually mature women under 50 years of age ranges from 0.001 to 0.0034 nmol / liter, biologically available testosterone - from 0.033 to 0.774 nmol / liter. For older women, the rates are 0.001–0.022 and 0.002–0.46 nmol/liter, respectively. The increased content of testosterone indicates the ovarian origin of hyperandrogenism; an increase in the concentration of DEA-sulfate - about hyperandrogenism of the adrenal genesis. Extremely high levels of testosterone and DEA sulfate may indicate a virilizing tumor.

In order to identify the pathology of the ovaries that caused ovarian hyperandrogenism, ultrasound of the pelvic organs and additional laboratory studies of the hormonal background with the determination of the level of estradiol, prolactin, luteinizing and follicle-stimulating hormones are prescribed.

In hyperandrogenic conditions 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. For the diagnosis of metabolic pathologies, laboratory tests are used:

• • samples with dexamethasone and human chorionic gonadotropin;
  • determination of the level of cholesterol and lipoproteins;
  • blood tests for sugar and glycated glycogen, glucose tolerance test;
  • tests with adrenocorticotropic hormone.

To improve the visualization of the 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 stable result only in the framework of the treatment of major diseases, such as PCOS or Itsenko-Cushing's syndrome, and concomitant pathologies - hypothyroidism, insulin resistance, hyperprolactinemia, etc.

Hyperandrogenic states of ovarian genesis are corrected with the help of estrogen-progestin oral contraceptives that suppress the secretion of ovarian hormones and block androgen receptors. With strong androgenic dermopathy, a 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 the metabolic syndrome, insulin synthesizers 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, the treatment of hyperandrogenism is a prerequisite for restoring reproductive function.

Prevention

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions. 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 adrenopathy, it is important to adhere to a healthy lifestyle and a gentle work and rest regimen, give up bad habits, limit the effects of stress, lead an orderly sex life, avoid abortions and emergency contraception; uncontrolled intake of hormonal drugs and anabolic drugs is strictly prohibited. Equally important is the control of body weight; moderate physical activity without heavy physical exertion is preferable.

Most often, hyperandrogenism in women is first diagnosed in 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. Long-term hyperandrogenism increases the risk of developing metabolic syndrome and type II diabetes mellitus, atherosclerosis, arterial hypertension and coronary disease hearts. According to some reports, high androgen activity correlates with the incidence of certain 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 suddenly be complicated by an adrenal crisis. Due to the possibility of a fatal outcome, at the first signs of acute adrenal insufficiency, the child should be immediately taken to the hospital.

Hyperandrogenism - an increase in the concentration of male sex hormones in women. Hyperandrogenic disorders can be explained by excessive secretion of androgens by the ovaries or adrenal glands.

Common symptoms of hyperandrogenism

Characteristic signs of hyperandrogenism can range from mild unwanted hair growth and acne to alopecia (baldness), excessive hirsutism, masculinization and virilization. Hirsutism is characterized by male-like hair growth associated with the transformation of vellus hair into terminal hair in areas such as the face, chest, abdomen, and upper thighs. Signs of masculinization include loss of body fat and a decrease in breast size. Virilization consists in the addition of temporal alopecia, a decrease in the timbre of the voice and an increase in the clitoris in response to any previous excessive influence of the male hormone in hyperandrogenism in women.

Hyperandrogenic disorders are divided into functional and neoplastic disorders of the adrenal glands or ovaries.

Causes of hyperandrogenism

• Diseases of the adrenal glands: hyperplasia of the adrenal glands; Cushing's syndrome; adenoma, adrenal carcinoma.
• Ovarian diseases: polycystic ovaries; HAIR-AN syndrome.
• Tumors of the ovaries: Sertoli-Leydig cells; chyle cells; lipoid cell tumors.
• Idiopathic hirsutism.

Congenital adrenal hyperplasia

VGN - general concept, used to describe various disorders resulting from congenital adrenal enzyme deficiency, accompanied by oversynthesis of steroids. The most common cause of CAH is a deficiency of 21-hydroxylase. CAH is represented by a spectrum of disorders, ranging from severe forms of salt wasting to virilization and non-classical CAH. Both salt wasting and simple virilization have been called classic forms of female hyperandrogenism because their symptoms (eg, salt loss or hermaphrodite genitalia in newborn girls) are noticeable at birth or occur shortly thereafter. On the other hand, there is a non-classical form called late onset, usually manifesting at puberty or later. These patients do not have genital anomalies associated with hyperandrogenism, but may develop hirsutism, acne, and ovulatory and menstrual disturbances.

Since 21-hydroxylase is responsible for the conversion of 17-hydroxyprogesterone to 11-deoxycortisol, its deficiency leads to excessive accumulation of 17-hydroxyprogesterone. As a result, an increase in 17-hydroxyprogesterone in the blood is found, as well as an increase in the synthesis of androstenedione and testosterone in the D4 metabolic pathway. Hyperandrogenism is inherited in an autosomal recessive manner.

Cushing's syndrome

Other serious illness adrenal glands, leading to excessive production of androgen and hyperandrogenism - Cushing's syndrome, or persistent hypercorticism. Characteristic Cushingoid features include trunk obesity, moon face, hypertension, bruising, impaired glucose tolerance, muscle loss, osteoporosis, striae on the abdominal skin, and fat deposits in the supraclavicular region and on the back of the neck. It is possible to detect other signs: hirsutism, acne, irregular menstruation. This disorder can develop with a cortisol-producing adrenal tumor or an ACTH-producing pituitary adenoma (Cushing's disease). It may be a rare cause of menstrual dysfunction in hyperandrogenism in women.

Tumors of the adrenal glands

Tumors of the adrenal glands leading to hyperandrogenism, in the absence of symptoms and signs of excess glucocorticoids, are extremely rare. Androgen-only adenomas tend to secrete large amounts of DHEAS. Adrenal carcinoma can synthesize large amounts of glucocorticoids.

polycystic ovary syndrome

About 6% of women of reproductive age have PCOS. This is a chronic disease characterized by anovulation or oligoovulation with clinical or laboratory signs hyperandrogenism, as well as the absence of symptoms of any other pathological condition. It usually develops during puberty. There is a hereditary predisposition to developing PCOS. First-generation relatives are more likely to develop PCOS.

The most common symptoms of PCOS are: hirsutism (90%), menstrual disorders(90%) and (75%). The occurrence of hirsutism in women who have used combined hormonal contraceptives for most of their lives and women of Asian descent is less likely. Many patients with PCOS suffer from abdominal obesity, and the prevalence of hyperandrogenism varies widely depending on the woman's country of origin. In the United States, the highest prevalence of obesity among women with PCOS is noted (about 60%).

In the ovaries of most patients, many inactive follicular cysts are found with a delay in the development of follicles at the mid-antral stage. Cysts are localized in the peripheral part of the cortical layer of the ovary. The ovarian stroma is hyperplastic and usually contains islets of luteinized androgen-producing theca cells. Approximately 20% of women with a normal hormonal status can also be found with polycystic ovaries.

Hyperandrogenism in women with PCOS occurs as a result of excessive synthesis of male sex hormones by the ovaries and often by the adrenal glands. The pathophysiological basis of hyperandrogenism in PCOS is unknown. Patients show an increased frequency of release of lutropin, usually leading to an increase in the concentration of this hormone in the bloodstream. This is probably due to an increase in the secretion of GnRH by the hypothalamus and an increase in the sensitivity of the pituitary gland to it.

An increase in the content of lutropin promotes the secretion of androgens by theca cells, which increases the concentration of androstenedione and testosterone produced by the ovary. This in turn causes atresia of many developing follicles and often prevents the development of a dominant or preovulatory follicle. The conversion of androgens to estrogens during hyperandrogenism in the periphery leads to an increase in estrogen concentration (compared to that at the beginning of the follicular phase), which suppresses the release of FSH from the pituitary gland. All this causes a disruption in the normal functioning of the ovary, so in the middle of the cycle there is no release of lutropin and anovulation occurs with hyperandrogenism in women. In some patients with PCOS, excessive androgen synthesis is found in both the adrenal glands and the ovaries. The mechanism of development of excessive production of androgens by the adrenal glands in PCOS is unknown.

In PCOS, there is an association between abnormal androgen production, insulin resistance, and hyperinsulinemia. Approximately 60-70% of patients with PCOS have reduced insulin sensitivity, its hypersecretion occurs. Hyperinsulinemia is associated with direct stimulation of insulin production by theca cells, leading to androgen secretion. An increase in the concentration of androgens and insulin in PCOS also contributes to a decrease in the synthesis of sex hormone-binding globulin in the liver and its secretion. In this case, the content of free testosterone can increase significantly, although the increase in the concentration of total testosterone will be moderate or insignificant. Thus, the severity of somatic symptoms of hyperandrogenism in PCOS depends on the content of total testosterone.

In the long term, insulin resistance associated with PCOS may lead to an increased risk of metabolic syndrome in women with hyperandrogenism (diabetes and heart disease). The action of estrogens in hyperandrogenism can lead to endometrial hyperplasia, and sometimes to endometrial cancer.

The diagnosis of PCOS continues to be somewhat questionable due to inconsistency in diagnostic criteria. PCOS is considered a diagnosis of exclusion. In addition, it is a syndrome, not a specific and easily diagnosed disease. The European Society for Human Reproduction and Embryology defines PCOS as a syndrome in which patients experience irregular ovulation, usually accompanied by oligomenorrhea, hyperandrogenism, or polycystic ovaries, when other causes of these symptoms are excluded.

Hyperandrogenic insulin resistance with acanthosis nigricans syndrome

Hyperandrogenism with acanthosis nigricans syndrome (HAIR-AN syndrome) is a hereditary hyperandrogenic disease characterized by severe insulin resistance, different from that of PCOS. With HAIR-AN syndrome, an extremely high concentration of circulating insulin is found (basal content - more than 80 IU / ml, after oral glucose - more than 500 IU / ml), associated with severe insulin resistance. Since insulin is a hormone with mitogenic activity, its extremely high content leads to hyperplasia of the basal layer of the skin epidermis, which causes the development of acanthosis black - hyperpigmentation of skin folds. In addition, as a result of the action of insulin on ovarian theca cells, many patients with HAIR-AN syndrome show their hyperplasia. Patients with this disease may develop severe hyperandrogenism and even virilization. In addition, these women are at significant risk of developing dyslipidemia, type 2 diabetes, hypertension, and cardiovascular disease. Such patients are especially difficult to treat, although the use of long-acting GnRH analogues is considered promising.

Neoplasms of the ovaries

Androgen-producing ovarian tumors occur in about one in 500 women with hirsutism. They include Sertoli-Leydig cells, chyle and lipoid cells. Virilization in hyperandrogenism is accompanied by stromal hyperplasia of surrounding non-hormone-producing ovarian neoplasms. Such tumors include cystic teratomas, Brenner tumors, serous cystadenomas, and Krukenberg tumors.

Idiopathic hirsutism

In some women, hirsutism is mild or medium degree and is not accompanied by an increase in the concentration of androgens in the blood. This condition is called idiopathic hirsutism, also erroneously referred to as "constitutional hirsutism". Idiopathic hirsutism in hyperandrogenism in women may develop due to increased tissue conversion of testosterone to the more biologically active DHT. Almost all disorders that cause hirsutism (such as PCOS, HAIR-AN syndrome, or CAH) are hereditary. True hirsutism is rarely constitutional and almost always indicates a predominantly androgenic disorder in women.

Diagnostics

History: Functional disorders such as PCOS or late onset CAH usually first appear during puberty and tend to progress slowly. In these disorders, the symptoms of androgen overexposure develop after several years. Unlike them, tumor diseases can occur at any time. More often they develop after puberty and begin suddenly. Hyperandrogenism progresses rapidly and is often preceded by virilization. Sometimes a combination with functional disorders is recorded. So, in 15% of patients with HAIR-AN syndrome, virilization symptoms are found in hyperandrogenism, in particular, severe hirsutism, temporal alopecia, and even some enlargement of the clitoris.

Physical examination

The severity of hyperandrogenism, hirsutism, acne, or androgenetic alopecia should be assessed and palpated thyroid gland. Patients should be actively questioned about excessive facial hair as they may mask hirsutism by waxing regularly and be reluctant to volunteer information. Look out for Cushingoid signs. Black acanthosis often indicates insulin resistance and hyperinsulinemia. With the help of a bimanual gynecological examination, it is possible to detect an increase in the ovaries with hyperandrogenism in women. An asymmetric increase associated with a sudden onset of virilization may indicate a rare androgen-producing tumor.

Laboratory tests for hyperandrogenism

Laboratory research in patients with virilization and / or severe hirsutism is performed mainly in order to rule out serious diseases.

Measurement of the basal concentration of 17-hydroxyprogesterone makes it possible to exclude 21-hydroxylase deficiency in CAH. When the content of this hormone is more than 2 ng / ml, the ACTH stimulation test, in which the concentration of 17-hydroxyprogesterone is determined, is considered the main diagnostic method. If Cushing's syndrome is suspected, either a measurement of the daily content of free cortisol in the urine, or a suppressive test with dexamethasone, should be performed. The last test for hyperandrogenism is to take dexamethasone 1 mg orally at night, followed by fasting blood cortisol levels at 8 a.m. (normal is less than 5 g / dl).

Measurement of the content of prolactin and TSH allows to exclude hyperprolactinemia and thyroid dysfunction. For patients with subtle signs of hyperandrogenism, it may be useful to assess the concentration of total and free testosterone, DHEAS in the blood. The content of DHEAS more than 7000 ng / ml or total testosterone more than 200 ng / dl gives grounds to suspect an androgen-producing tumor of the adrenal glands or ovaries. However, the best indicator of this disease, however rare, is the clinical symptoms. Signs of virilization are present in 98% of patients with tumors, regardless of the concentration of testosterone in hyperandrogenism in women.

Pelvic organs to rule out an ovarian tumor should be performed for any risk factors. Androgen-producing adrenal tumors can be detected by CT or MRI. If clinical or laboratory results indicate an androgen-producing tumor with hyperandrogenism and its localization cannot be determined using tomographic research methods, selective venous catheterization and measurement of androgen concentration in venous blood from each adrenal gland and ovary are performed.

In patients with PCOS and HAIR-AN syndrome, metabolic status should be assessed. Although glucose measurement in hyperandrogenism is sufficient for mass testing for diabetes, in patients with PCOS, glucose tolerance should be determined for a thorough check. In persons over 35 years of age, young patients with signs of metabolic disorders (for example, with HAIR-AN syndrome), the concentration of lipids in the blood should be determined.

Treatment

When choosing a treatment for hyperandrogenism, one should be guided by the etiology of the disease, the severity of clinical symptoms and the desire of the patient. In rare cases, with a tumor of the ovaries or adrenal glands, it is recommended to remove it surgically. In premenopausal women with an ovarian tumor, unilateral salpingo-oophorectomy is sufficient (removal of the ovary with fallopian tube), which allows you to save childbearing function. Treatment of postmenopausal women consists of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In patients with Cushing's syndrome, surgical removal a source (adrenal or pituitary tumors) that overproduces cortisol or ACTH.

Of course, PCOS is the most common functional ovarian disease that causes hyperandrogenism, and the management of PCOS depends on the description of the disease by the patient and his desire. Treatment of hirsutism in patients with PCOS is to suppress ovarian function. This is usually achieved by taking combined OK. In the treatment of estrogens and progesterone, the release of gonadotropins (FSH and lutropin) is suppressed, which helps to reduce the hyperproduction of testosterone and androstenedione by the ovaries. Estrogens also stimulate the synthesis of sex hormone-binding globulin, which reduces the concentration of free testosterone.

For effective treatment of hirsutism in hyperandrogenism, androgen blockers are additionally prescribed. Spironolactone is the most commonly used drug for the treatment of hyperandrogenism and hirsutism in women in the United States. This aldosterone antagonist binds competitively to testosterone, producing a direct antiandrogenic effect on target tissues. In addition, spironolactone affects steroid enzymes and reduces testosterone production. Since this drug for hyperandrogenism in women is an aldosterone antagonist, an increase in the concentration of potassium in the blood is possible. Other drugs that block the binding of androgens to their receptors include flutamide and cyproterone, while finasteride inhibits the conversion of testosterone to its more active metabolite, DHT. It may take up to 6 months to achieve cosmetic improvement, and the maximum effect develops within two years.

Suppression of excess androgen production or their action usually prevents further hair growth, but the cause that causes hirsutism does not disappear immediately. To obtain a good cosmetic result in hyperandrogenism, removal of unwanted hair in some areas is usually required in combination with biochemical treatment. Topical treatments for hyperandrogenism include shaving, hair removal cream, electrolysis, and laser hair removal. Individual hairs should not be removed, as this may stimulate the development of surrounding hair follicles.

All patients suffering from hyperandrogenism, PCOS and chronic anovulation are at risk of endometrial cancer. That is why when treating women not taking combined OCs, it should always be planned to stop taking progestin-inducing drugs to protect the endometrium and reduce risk. For this purpose, it is recommended to take orally medroxyprogesterone at a dose of 10 mg daily, micronized progesterone 100 mg 2 times / day, or norethindrone 5 mg daily for 12-14 days every other month.

Insulin resistance and hyperandrogenism in many patients with PCOS may influence the risk of diabetes and possibly cardiovascular disease. Women with PCOS tend to have higher cholesterol levels. In addition, they have a high risk of developing arterial hypertension with hyperandrogenism. Thus, patients with PCOS and chronic anovulation should be advised on weight loss, diet, physical activity, and other lifestyle changes that will reduce the risk of diabetes.

Patients with functional adrenal hyperandrogenism (eg, CAH) are given glucocorticoids (eg, dexamethasone 0.25 mg at bedtime every other day). Many of these women also require drugs that suppress ovarian androgen secretion. For this, combined OK and antiandrogens are prescribed.

The article was prepared and edited by: surgeon

Hyperandrogenism is a general term for 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 in reproductive age - from 25 to 45 years; less often - in girls in adolescence.

Source: clinic-bioss.ru

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions.

Causes

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

• increased levels of androgens in the blood serum;
• conversion of androgens to 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 impaired ovarian function. The most common 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, hypothalamus and adrenal glands. The incidence of PCOS among women of childbearing age reaches 5-10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

• adrenogenital syndrome;
• congenital adrenal hyperplasia;
• galactorrhea-amenorrhea syndrome;
• stromal tecomatosis 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 body hair, and in rare cases, hair loss on the head.

Compensatory hyperproduction of insulin stimulates the production of ovarian cells that produce androgens. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptor cells in the tissues of the ovaries, 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;
• excess body weight;
• 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.

Kinds

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

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

• ovarian, or ovarian;
• adrenal, or adrenal;
• mixed - simultaneously there are signs of ovarian and adrenal forms.

Relative hyperandrogenism occurs against the background of the normal content of male hormones with excessive sensitivity of target tissues to sex steroids or enhanced transformation of the latter into metabolically active forms. In a separate category, iatrogenic hyperandrogenic conditions are distinguished, which have developed as a result of prolonged use of hormonal drugs.

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 conditions is characterized by a wide variety of manifestations that fit into the standard set 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 hyperandrogenism of ovarian genesis, which is accompanied by abnormalities in the development of follicles, hyperplasia and uneven exfoliation of the endometrium, and cystic changes in the ovaries. Patients complain of scanty and painful menstruation, irregular or anovulatory cycles, uterine bleeding, and premenstrual syndrome. With the syndrome of galactorrhea-amenorrhea, there is a deficiency of progesterone.

Severe metabolic disorders - dyslipoproteinemia, insulin resistance and hypothyroidism are characteristic of the primary pituitary and adrenal forms of hyperandrogenism. Approximately 40% of patients have male-type abdominal obesity 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, breast underdevelopment, a decrease in the timbre of the voice, an increase in muscle mass and body hair are noted; for girls, it is typical later than menarche. 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 activity of dihydrotestosterone. The effect of a hormone that stimulates the secretory activity of the skin glands changes the physicochemical properties of sebum, causing blockage of the excretory ducts and inflammation of the sebaceous glands. As a result, 70-85% of patients with hyperandrogenism have signs of acne - acne, dilated skin pores and comedones.

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

Less common are other manifestations of androgenetic 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 coarse 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, shins and internal side of the thigh. In postmenopausal women, bitemporal and parietal alopecia are occasionally noted - hair loss at the temples and in the crown area, respectively.

Source: woman-mag.ru

Features of the course of hyperandrogenism in children

In the prepubertal 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 pronounced virilization of the girl and anomalies in the structure of the genitals. With adrenogenital syndrome, there may be signs of false hermaphroditism: clitoral hypertrophy, fusion of the labia majora and vaginal opening, displacement of the urethra to the clitoris, and urethrogenital sinus. At the same time, there are:

• early overgrowth of fontanelles and epiphyseal fissures in infancy;
• premature body hair;
• rapid somatic growth;
• delayed puberty;
• Late menarche or no menses.

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 severe adrenogenital syndrome, the development of an adrenal crisis is possible - acute adrenal insufficiency, associated with a threat to life. Parents should be alerted by 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 ovaries. The debut of PCOS often occurs at the stage of formation of menstrual function.

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

In hyperandrogenic conditions 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. For the diagnosis of metabolic pathologies, laboratory tests are used:

• samples with dexamethasone and human chorionic gonadotropin;
• determination of the level of cholesterol and lipoproteins;
• blood tests for sugar and glycated glycogen, glucose tolerance test;
• tests with adrenocorticotropic hormone.

To improve the visualization of the 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 stable result only in the framework of the treatment of major diseases, such as PCOS or Itsenko-Cushing's syndrome, and concomitant pathologies - hypothyroidism, insulin resistance, hyperprolactinemia, etc.

Hyperandrogenic states of ovarian genesis are corrected with the help of estrogen-progestin oral contraceptives that suppress the secretion of ovarian hormones and block androgen receptors. With strong androgenic dermopathy, a 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 the metabolic syndrome, insulin synthesizers 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, the treatment of hyperandrogenism is a prerequisite for restoring reproductive function.

Prevention

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions. 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 adrenopathy, it is important to adhere to a healthy lifestyle and a gentle work and rest regimen, give up bad habits, limit the effects of stress, lead an orderly sex life, avoid abortions and emergency contraception; uncontrolled intake of hormonal drugs and anabolic drugs is strictly prohibited. Equally important is the control of body weight; moderate physical activity without heavy physical exertion is preferable.

Most often, hyperandrogenism in women is first diagnosed in 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. Long-term 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 certain 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 suddenly be complicated by an adrenal crisis. Due to the possibility of a fatal outcome, at the first signs of acute adrenal insufficiency, the child should be immediately taken to the hospital.

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Hyperandrogenism in women is an increased content of male sex hormones (testosterone). He is the forerunner. The transformation is under the influence of the aromatase enzyme. Testosterone is produced in the weaker sex in the adrenal glands, ovaries and adipose tissue. "Breakdown" at any of these levels can lead to different types of hyperandrogenism in women.

The main types of hyperandrogenism in women

To date, depending on the causes of the origin of hyperandrogenism, its two main forms are distinguished. This is true and others. True include ovarian and adrenal hyperandrogenism. By origin, they can be functional and tumor.

Functional true hyperandrogenism in women and their causes:

• Ovarian hyperandrogenism. It is associated with a deficiency of the aromatase enzyme, which ensures the conversion of testosterone to estrogen. As a rule, this is a congenital defect. Mild hyperandrogenism of ovarian genesis is often found - erased forms (testosterone levels may be normal, there may be no ultrasound signs of sclerocystic ovaries).
• Adrenal hyperandrogenism. It is associated with a lack of an enzyme that converts testosterone precursors. Symptoms of adrenal hyperandrogenism: characterized by significant elevated levels of testosterone and as a manifestation of this - hirsutism;

Other forms include:

• Transport. Associated with deficiency of sex hormone-binding globulin (SHBG). This globulin binds and prevents it from entering the cell of the target organ. SHBG is produced in the liver, and its levels depend on the functioning of the thyroid gland and the amount of estrogen.
• metabolic hyperandrogenism. It is associated with a violation of carbohydrate and fat metabolism. It is based on insulin resistance;
• Hyperandrogenism of mixed origin. A combination of various forms and causes that cause hyperandrogenism syndrome in women;
• Iatrogenic. Occurs as a result of the action of various medications.

The main symptoms of hyperandrogenism

Target organs for the action of testosterone: ovaries, skin, sebaceous and sweat, as well as mammary glands, hair. The leading symptoms of hyperandrogenism in women are the following manifestations:

1. (maturation and release of the egg), which can provoke infertility and lead to hyperestrogenism. Long-term hyperestrogenism is a risk in hormone-dependent organs (uterus, ovaries);
2. Insulin resistance (insensitivity of tissues to insulin, as a result of which the cell does not absorb glucose and remains “hungry”). Leads to the development of type 2 diabetes;
3. Hirsutism. Signs of hyperandrogenism in this case: hair growth in androgenic zones (on the beard, chest, front abdominal wall, arms, legs, back);
4. Skin manifestations (acne, seborrhea, androgen-dependent alopecia)
5. Sclerocystic ovaries: enlarged, with a dense albuginea, but many maturing follicles located on the periphery. A "necklace" symptom is created.

The diagnosis of hyperandrogenism is based on at least two of the above symptoms.

Diagnosis of hyperandrogenism in women

Treatment of hyperandrogenism in women depends on the correct diagnosis of the cause and type of this syndrome. Diagnostics consists of the following steps:

• Complaints about increased hair growth in places atypical for women, acne, infertility, menstrual irregularities, often obesity;
• Anamnesis: manifestations of hyperandrogenism syndromes coincide with the period of puberty and reproductive age;
• Inspection data: obesity, hirsutism, the above skin manifestations;
• Hormonal examination data: elevated levels of free testosterone, adrenocorticotropic hormone, dehydroepistendinone, prolactin;
• Ultrasound data: sclerocystic ovaries, an increase in the volume of the ovaries or their tumors, tumors of the adrenal glands;
• Decrease in the level of globulin that binds sex hormones;
• Elevated insulin levels and impaired glucose tolerance.

Treatment of hyperandrogenism in women

Can hyperandrogenism be cured? True functional hyperandrogenism is not cured because it is associated with congenital enzyme defects. Treatment is carried out to eliminate certain symptoms of hyperandrogenism in women. After stopping treatment, the symptoms of hyperandrogenism may recur.

Treatment of hyperandrogenism in women of ovarian genesis consists in the use of steroid antiandrogen drugs (Diana 35, Cyproterone, Levonorgestrel) and non-steroidal (Flutamine) types.

In the treatment of adrenal hyperandrogenism, Dexamethasone is used.

Treatment of hyperandrogenism associated with metabolic disorders consists in, increased physical activity and reducing agents, such as Metformin.

The syndrome of hyperandrogenism in women associated with an increase in the level of prolactin requires the appointment of prolactin-lowering drugs (Alactin, Bromkriptin).

Treatment of hyperandrogenism of tumor genesis consists in the surgical removal of these formations on the ovaries, adrenal glands, and pituitary gland.

Hyperandrogenism in girls at an early age, as a rule, is associated with an adrenal sure syndrome of tumor genesis, requiring surgical treatment. Functional hyperandrogenism in children appears during puberty.

Hyperandrogenism during pregnancy

Infertility is not always the result of hyperandrogenism. However, it causes a violation of the production of estrogen hormones and. With hyperandrogenism syndrome, this hormone is reduced. with this syndrome, the appointment of natural progesterone preparations is indicated, especially in the first trimester, when the placenta is “forming”. Hyperandrogenism during pregnancy is a risk factor for miscarriage and prematurity, the development of metabolic syndrome in children.

You probably paid attention to women who have masculine features in their appearance. This may be a low voice, the appearance of facial and body hair, a typical male body structure, and the like.

This situation is most often caused by excessive secretion of androgens or their increased effect on the woman's body. In medicine, such a pathology is defined as hyperandrogenism.

Symptoms, causes and ways to deal with it, we will consider in this article.

What causes hyperandrogenism?

The described disease is the most common violation of the functions of the endocrine system in women. As a result of the research, it was found that 20% of the representatives of the weaker sex have a diagnosis of hyperandrogenism.

In women, this condition is usually caused not only by an excess of male sex hormones produced by the ovaries or adrenal glands. Pathology is also provoked by an increase in the conversion of androgen precursors into their even more active form (for example, testosterone becomes dihydrotestosterone, which is 2.5 times more active). The situation is aggravated by an increase in androgen utilization, driven by hypersensitivity organ (eg skin) to this hormone.

Some features of the development of hyperandrogenism

So, hyperandrogenism in women, the symptoms of which are manifested, in particular, acne (acne), develops with an increase in sensitivity to androgens in the sebaceous glands. Note that the level of male sex hormones in the patient's blood remains normal!

In addition, the development of hyperandrogenism is also affected by a decrease in the amount of globulin that binds sex hormones (normally, it prevents free testosterone from penetrating into the blood cell and interacting with androgen receptors).

Synthesis of globulin occurs in the liver, so dysfunction of this organ can provoke the onset of hyperandrogenism or spur its development. The same effect has a decrease in the level of estrogen produced by the thyroid gland.

Signs of hyperandrogenism in women

Hyperandrogenism can be manifested by virilization, that is, the appearance of male characteristics in a woman. As a rule, this is expressed in the hairiness of the chest area, the midline of the abdomen, the inner side of the thighs and increased facial hair growth. But in the hair on the head at this time, bald patches (the so-called alopecia) may appear. In addition, pathology is often accompanied by cosmetic defects: acne (acne), peeling and inflammation of the skin on the face (seborrhea), as well as atrophy of the muscles of the abdomen and limbs.

Women with hyperandrogenism are characterized by menstrual irregularities or amenorrhea (absence of menstruation), obesity, hypertension, myocardial hypertrophy, and infertility.

In addition to all of the above, women suffering from the described pathology usually have an increased susceptibility to various types of infections, a tendency to depression, and increased fatigue.

By the way, remember that this pathology has no age. Hyperandrogenism in women can manifest itself at any time in life, starting from birth.

How is hyperandrogenism diagnosed?

The described diagnosis cannot be made only on the basis of external signs that the patient has. Even when they seem very eloquent. A number of tests and ultrasounds are required internal organs. And the key method for diagnosing this pathology is a blood test for the amount of steroids.

Please note that the patient's condition may also be manifested by the presence of diabetes mellitus, Cushing's syndrome (which is externally expressed by obesity, a moon-shaped face and thinning of the limbs), polycystic ovaries, adrenal tumors, etc.

As you can see, all this involves a variety of methods by which hyperandrogenism in women will be diagnosed.

How to distinguish between hirsutism and hypertrichosis?

As mentioned above, one of the earliest and most persistent symptoms of the onset of the described pathology in women is excessive hair growth on the face and body (hirsutism).

But such a sign should not be confused with hypertrichosis - a condition in which hair growth occurs on any part of the body, including where hair growth does not depend on the action of androgens.

And the syndrome of hyperandrogenism in women provokes the appearance of hair in such places, that is, according to the male type: on the face (beard and mustache), on the chest, inner thighs, on the abdomen and lower back, and also between the buttocks.

A patient with hirsutism is usually offered a treatment that includes both cosmetic measures (epilation) and hormonal correction.

The effect of androgens on hair growth in women

How is hair growth related to the production of androgens in a woman's body? The fact is that it is the amount of this hormone that determines how and where hair will grow on a woman’s body. So, during the onset of sexual development, in a girl, under the influence of androgens, a small amount of hairs appear under the armpits and on the pubis.

But if the level of hormones begins to exceed the norm, then hair will appear on the face, and on the chest, and on the stomach. And a very high level of androgens causes, in addition, a decrease in hair growth on the head, which is why bald patches appear above the forehead.

Moreover, please note that this hormone does not affect the growth of vellus hair, as well as eyelashes and eyebrows.

How does ovarian hyperandrogenism develop?

In medicine, there are three forms of the described disease: ovarian, adrenal and mixed.

The development of the first form of pathology leads to a deficiency of enzymes contained in the ovaries (we are talking, as a rule, about hereditary pathology). This prevents the conversion of androgens into female sex hormones - estrogens and, accordingly, causes their accumulation. As a result, the woman develops ovarian hyperandrogenism.

By the way, which androgens (testosterone, DEA-sulfate or androstenedione) will prevail in the patient's blood directly depends on which enzymes are lacking in her body.

How is the functioning of the ovaries disturbed?

The ovarian form of the disease is most often characterized by polycystic and hyperthecosis (bilateral enlargement) of this organ. By the way, girls involved in power sports have a high risk of acquiring this pathology.

This is due to the fact that an excess level of androgens stops the growth of the follicles that make up the ovaries, eventually leading to their overgrowth (the so-called follicular atresia). In addition, it stimulates the development of pathological formation of fibrous connective tissue (fibrosis) and causes polycystic disease.

According to the feedback principle, this syndrome of hyperandrogenism in women leads to a failure in the central regulation of androgen levels (at the level of the pituitary and hypothalamus), which, in turn, greatly changes the hormonal background.

Adrenal hyperandrogenism

Now let's talk about adrenal hyperandrogenism. You probably know that the adrenal glands are a pair of small endocrine glands that sit above the kidneys. They, by the way, produce 95% androgen called DEA sulfate.

A feature of the pathology of this organ is that adrenal hyperandrogenism in women is most often congenital. It occurs as a result of androgenital syndrome.

A similar syndrome is caused by the absence of enzymes that contribute to the production of glucocorticoid hormones, which are normally produced by the adrenal cortex. This leads to the fact that their precursors (progesterone, pregnenolone, etc.) accumulate in the blood, forcing the body to use them for excess production of androgens.

Less common is hyperandrogenism caused by tumors of the adrenal glands that secrete androgens (this pathology is called Itsenko-Cushing's disease).

Mixed hyperandrogenism

Mixed hyperandrogenism in women also occurs periodically. The causes of its occurrence lie in the simultaneous violation of the functions of the ovaries and adrenal glands.

Due to the increase in the level of adrenal androgens, their formation in the ovaries also increases, and the increased content in the blood of the latter stimulates the pituitary gland, forcing it to increase the production of luteinizing hormone, which provokes the formation of hyperandrogenic syndrome.

The mixed form also occurs as a result of trauma, pituitary tumors or brain intoxication in a woman.

Why is hyperandrogenism dangerous during pregnancy?

In addition to the problems listed above, the described pathology is dangerous for women who want to conceive and bear a child. For example, hyperandrogenism during pregnancy is the cause of 20 to 40% of miscarriages or fetal fading that occur in the early stages.

And note that this state of affairs is sad already because abortion itself exacerbates hormonal disorders. And in this case, against the background of existing hormonal changes, this ultimately leads to the fact that pregnancy becomes impossible in the future.

Pregnancy prognosis with hyperandrogenism

If a woman turns to a specialist with specific complaints that were listed above, then she will definitely be scheduled for an examination to exclude the described pathology.

With proper diagnosis and adequate treatment, hyperandrogenism during pregnancy does not prevent the patient from successfully bearing and giving birth to a child. This is helped by drugs that reduce the level of androgens in the blood. Their patient must be taken regularly throughout the duration of pregnancy.

How is hyperandrogenism treated?

Before starting the treatment of hyperandrogenism in women, a detailed examination is required to identify the type of disease and the causes that provoked its development.

If a woman does not plan to have a child, then the doctor selects oral contraceptives for the patient, which have an antiandrogenic effect. In the opposite case, drugs are prescribed that stimulate the release of the egg, and sometimes a wedge-shaped excision of the ovary is used to help the egg come out of it.

In the case of a high level of androgens that the body cannot utilize, patients are usually prescribed the drugs Dexamethasone and Metipret, which increase the amount of female hormones in the body.

If the disease is provoked by the presence of a tumor, then the patient is shown surgery. To the same forces specialists and polycystic ovaries. As a rule, most of it is removed.

In the adrenal form of the disease, hormone therapy is used, including glucocorticoid hormones (for example, Dexamethasone). By the way, it is prescribed in a maintenance dose during pregnancy.

Medicines used to treat hyperandrogenism

To improve the condition of the skin in the described disease, the drug "Diana-35" is used, which suppresses the production of androgens by the adrenal glands and ovaries, as well as the release of luteinizing hormone into the woman's blood by the pituitary gland. At the same time, cyproterone acetate, which is part of the drug, blocks androgen-sensitive skin receptors, preventing them from binding to them.

As a rule, to increase the effectiveness of the named drug, it is prescribed in combination with Androkur. These drugs help women with severe acne. But their effect can be assessed only 3 months after the start of treatment.

Therapy with antiandrogenic drugs "Yanina" and "Zhanin" is also very effective. Treatment of hyperandrogenism in women with the help of these drugs lasts at least six months. It does not cause an increase in body weight and contributes to the normalization of the menstrual cycle.

Are there folk remedies that help with hyperandrogenism?

A fairly wide range of medicinal herbs are known, which are included in metabolic processes the female body and positively affect the processes of regulating the balance of hormones.

Of course, with such a disease as hyperandrogenism, treatment with folk remedies is not a panacea at all, but, for example, a remedy such as cimifuga (or, in a different way, black cohosh) can help in cases of hormonal imbalance. No less effective is the sacred rod, on the basis of which the drug "Cyclodinone" is produced.

However, you can list a whole list of representatives of the flora, which, along with the drugs prescribed by a specialist, will help regulate hormonal balance: licorice root, mint, angelica, evading peony, etc. Ready-made collections of such plants are sold in the pharmacy network and are always ready to alleviate the condition of a woman.

A few last words

Do not try to treat the pathology yourself! If you have been diagnosed with "hyperandrogenism", reviews of friends or relatives about any "magic" remedies will not help solve the problem.

Incorrect treatment can have very serious consequences for a woman. Therefore, if a disease is suspected, it is first necessary to contact a gynecologist and an endocrinologist. Their joint efforts and your patience and perseverance will help stop the development of pathology and prevent irreversible consequences.

Hyperandrogenism syndrome in women is an endocrine pathology that develops as a result of excessive activity of androgens (male sex hormones) in the body. This deviation occurs as often as the pathology of the thyroid gland. There are many factors that can trigger this disease:

• Cushing's syndrome (increased levels of hormones in the adrenal cortex);
• Thyroid disease;
• Hormone-producing ovarian tumors;
• Frenkel's disease (overgrown ovarian stroma);
• The action of hormonal drugs;
• Liver diseases that have become chronic;
• The presence of hyperandrogenism syndrome in the next of kin;
• polycystic ovaries;
• A benign pituitary tumor (prolactinoma) that produces a hormone (prolactin) that is responsible for breast development and milk production
• Excess production of androgens by the adrenal glands.

There are 3 types of hyperandrogenism: mixed, adrenal and ovarian. Also, hyperandrogenism is divided into primary (impaired functioning of the adrenal cortex or ovaries) and secondary (malfunctions of the hypothalamus and pituitary gland), congenital and acquired.

The clinical picture of the disease can be bright and mild. Main symptoms:

1. Acne is a skin disease caused by inflammation of the sebaceous glands. It is one of the factors in the origin and development of hyperandrogenism syndrome. This disease is characteristic of the pubertal stage of development, because signs of acne (red painful acne, black dots, comedones) are observed in most adolescents. If such inflammations on the skin do not go away even in adulthood, one should be examined for hyperandrogenism, which, in turn, may be due to polycystic ovaries. In some cases, acne is accompanied by seborrhea (excessive activity of the sebaceous glands in certain areas of the skin), which can be caused by androgens.
2. Alopecia is called rapid baldness. With androgenetic alopecia, a change in the hair structure occurs. At first, the hair becomes very thin and colorless, and then it begins to fall out. This sign suggests that hyperandrogenism has been progressing for a long time.
3. Hirsutism - the appearance of an excessive amount of hard and dark hair on the face, arms, chest. This disease is almost always accompanied by infertility and scanty menstruation.

Viral Syndrome. Virilization is a rare pathology in which a woman exhibits exclusively male features. Causes of the viril syndrome can be a neoplasm on the adrenal glands, adrenoblastoma, and ovarian hyperplasia. During virilization, the following symptoms are observed:

• Irregular menstruation, amenorrhea;
• Increased libido;
• acne;
• Changing the timbre of the voice;
• Increase in muscle mass;
• Enlargement and swelling of the clitoris;
• Extra weight in the upper body;
• Alopecia (baldness in the parting area);
• Hair growth around the nipples, on the abdomen, cheeks.

There are also symptoms that are much less common:

• arterial hypertension;
• Obesity;
• Diabetes mellitus type 2;
• Cell receptor sensitivity to male hormones.

Hyperandrogenism syndrome can occur at any age. Girls suffering from this disease are prone to depression, overwork and colds. Signs of pathology can also be caused by a lack of estrogens (female sex hormones) and a lack of a protein that regulates androgen activity.

Diagnostics

Many inexperienced doctors diagnose hyperandrogenism only if a large number androgens in the body. For this reason, women with hyperandrogenism, whose androgen levels are normal, do not receive timely treatment. As a result, the signs of the disease become more pronounced, the patient's health worsens. In most cases, hyperandrogenism syndrome occurs with a moderate amount of androgens.

When diagnosing use: laboratory research genes, analysis for the concentration of dehydroepiandrosterone sulfate and instrumental methods of examination (ultrasound, scintigraphy, CT, MRI), make an anamnesis (when the symptoms first appeared, what medications the woman has been taking recently). A clinical examination of the patient is carried out: skin rashes, excessive hair growth, coarsening of the voice timbre, body hair structure and gynecological examination (the size of the clitoris and labia). At the same time, experts determine the level of testosterone, follicle-stimulating and luteinizing hormones. But not all women need to study the hormonal background. With symptoms such as acne and seborrhea, the level of male sex hormones usually does not exceed the norm, so standard procedures will be quite enough.

Hirsutism is a more accurate diagnostic indicator of increased activity of male hormones than a high level of testosterone in the blood. The second indicator may be normal despite the fact that the signs of the disease have long appeared.

Androgenetic alopecia is considered one of the most important diagnostic criteria. Important is the fact that first the hair falls out on the temples, and then on the parietal region.

Treatment and prevention

Treatment for a woman is prescribed taking into account the form of hyperandrogenism and the reasons that caused it. If the disease was provoked by tumors of the adrenal glands and ovaries, it is necessary to remove them surgically. If the cause was not tumors, but malfunctions in the functioning of the pituitary and hypothalamus, then the therapy will depend on the goal that the woman wants to achieve during treatment. Such goals may include the elimination of symptoms and signs of the disease and the restoration of fertility. In the event of malfunction of the named areas of the brain, a woman becomes overweight, therefore its normalization is the main stage of treatment. To do this, you need to adjust the diet, go in for sports.

If a woman does not plan a child, but wants to get rid of the unaesthetic manifestations of hyperandrogenism, she is prescribed antiandrogenic oral contraceptives (Diana - 35).

In the event that the disease has arisen due to the absence of an enzyme that transforms male sex hormones into glucocorticoids, drugs such as Metipred and Dexamethasone are prescribed.

In case of violation of reproductive function, which is associated with ovarian or adrenal hyperandrogenism, a woman is prescribed drugs that cause the egg to come out of the ovary (Clomiphene).

If the drugs did not help to completely get rid of the disease, surgical methods are used. The most popular of these is laparoscopy. It is carried out by introducing abdominal cavity a special device that displays the image on the screen. After that, a second incision is made, through which, with the help of surgical instruments, peculiar “notches” are applied to the ovaries so that the egg can freely exit.

To prevent the disease, you should visit a gynecologist several times a year, monitor weight fluctuations, adhere to proper nutrition, give up bad habits, treat liver and thyroid diseases in time, and avoid stressful situations.

Folk methods of treatment

Folk methods will not help to completely cure the syndrome of hyperandrogenism in women, but they are very good as an aid. Here are some of the most effective recipes:

• Basil tincture. Add 2 tablespoons to a glass of boiling water, then boil the mixture again, keep it on low heat for another 10 minutes. After that, cool the broth, strain. You need to take 2-3 times a day, 100 ml.
• Infusion of boron uterus. First you need to dry about 50 g of the leaves of the plant. After that, crumble them, mix with 500 ml of vodka. Pour the mixture into a container, leave for a month. The tincture should not be exposed to light. You need to take at least 4 times a day, 35 drops.
• Licorice tincture. Add one tablespoon of licorice to a container of boiling water (200 ml). Leave the infusion for an hour, and then strain. The whole infusion should be drunk on an empty stomach in the morning.
• Herbal collection of red brush, motherwort, mountain ash, nettle, viburnum bark, chamomile, shepherd's purse. Grind all these herbs with a blender, mix. Add 2 tablespoons of the mixture to 500 ml of boiling water, leave to infuse for 7-8 hours. You need to drink the tincture in one day. It is necessary to use the collection for 2-3 months.
• Red brush tincture. Add one tablespoon of the purified plant to a container of boiling water (200 ml). Leave the broth to infuse (for one hour), then strain, cool. Take the infusion at least three times a day half an hour before meals.
• Collection of red brush and leuzea. Grind herbs, mix them. Then pour one teaspoon of the mixture into water (one glass). Take the infusion 3-4 times a day half an hour before meals.

Please note that the use of a red brush for hypertension is strictly contraindicated. In addition, any self-treatment, including folk methods without consulting a doctor can cause serious harm to health.