Postmenopausal hyperandrogenism

Abstract

Postmenopausal hyperandrogenism is a state of relative or absolute androgen excess originating from the adrenal glands and/or ovaries clinically manifested by the presence of terminal hair in androgen-dependent areas of the body, and other manifestations of hyperandrogenism such as acne and alopecia or the development of virilization. In such circumstances, physicians must exclude the possibility of rare but serious androgen-producing tumors of the adrenal glands or ovaries. Worsening of undiagnosed hyperandrogenic disorders such as polycystic ovary syndrome, congenital adrenal hyperplasia, ovarian hyperthecosis, Cushing syndrome and iatrogenic hyperandrogenism should be considered for differential diagnosis. Elevated serum testosterone not only causes virilizing effects, but also will lead to hypercholesterolemia, insulin resistance, hypertension and cardiac disease. An ovarian androgen-secreting tumor, which is diagnosed in 1–3 of 1000 patients presenting with hirsutism, comprises less than 0.5% of all ovarian tumors. Adrenal tumors, including non-malignant adenomas and malignant carcinomas, are less common than ovarian tumors but cause postmenopausal virilization. Measurement of serum testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, androstenedione and inhibin B is necessary in postmenopausal women with the complaints and signs of hyperandrogenism. Some tests to discard Cushing syndrome should also be done. After an etiological source of androgen hypersecretion has been suspected, we recommend performing magnetic resonance imaging of the adrenal glands or ovaries. Medical management with gonadotropin-releasing hormone agonist/analogues or antagonists has been reported for women who are either unfit for surgery or in whom the source of elevated testosterone is unidentified.

绝经后雄激素过多症 摘要

绝经后雄激素过多症是一种来源于肾上腺和/或卵巢的雄激素相对或绝对过多状态, 临床表现为身体雄激素依赖性区域出现终毛, 以及其他高雄激素的表现, 如痤疮、脱发或男性化改变。在这种情况下, 医生必须排除罕见但严重的产生雄激素的肾上腺或卵巢肿瘤。鉴别诊断需要考虑：未被诊断的疾病的恶化, 如多囊卵巢综合征、先天性肾上腺增生、卵泡膜细胞增殖、库欣综合征、医源性高雄激素血症等。血清睾酮升高不仅会导致男性化改变, 还会导致高胆固醇血症、胰岛素抵抗、高血压和心脏病。每1000名多毛患者中有1∼3人被诊断为分泌雄激素的卵巢肿瘤, 占所有卵巢肿瘤的0.5%不到。肾上腺肿瘤, 包括非恶性腺瘤和恶性肿瘤, 比卵巢肿瘤少见, 但会导致绝经后男性化。对有高雄激素症状和体征的绝经后妇女, 有必要检测血清睾酮、性激素结合球蛋白、硫酸脱氢表雄酮、雄烯二酮和抑制素B。还应做一些排除库欣综合征的检查。怀疑有雄激素分泌过多时, 建议行肾上腺或卵巢核磁共振成像。据报道, 促性腺激素释放激素激动剂/类似物或拮抗剂治疗适用于不适合手术或升高的睾酮来源不明的妇女。

Keywords:

• Postmenopausal
• hyperandrogenism
• androgen-secreting ovarian tumor
• hyperthecosis
• adrenal tumor

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.