Adrenal hyperandrogenism: when a woman looks like a man

Women who look like men – In today's world, this phrase takes on a special meaning. For many years, women have been taking on men's responsibilities: they actively work and earn money, have elements of men's clothing in their wardrobe, and often cultivate masculine character traits in themselves. At the same time, virilization – the appearance in women of secondary sexual characteristics characteristic of men – is a pathological condition of the body. It is impossible not to give due place to the stress factor, which plays an important role in the pathology of the female reproductive system. Adrenal hyperandrogenism – abnormal production of male sex hormones in the female body, is one of the most important diseases, manifested by symptoms of virilization.

Adrenal hyperandrogenism: causes and clinical picture

Adrenal hyperandrogenism is a genetically determined pathology resulting from congenital  dysfunction of the adrenal cortex. With this disease, the synthesis of steroids in the adrenal glands is disrupted: increased production of androgens suppresses the production of follicle-stimulating and luteinizing hormones, which play an important role in the normal functioning of the female reproductive system. At the same time, women experience virilization symptoms, the menstrual cycle is disturbed and infertility occurs.

Adrenal hyperandrogenism:

• what happens in the ovaries in adrenal hyperandrogenism;
• clinical picture of the classical form of adrenal hyperandrogenism;
• what are the symptoms of the pubertal form of adrenal hyperandrogenism;
• disorders of reproductive function in post-pubertal form of hyperandrogenism.

What happens in the ovaries in adrenal hyperandrogenism

Virilization of adrenal genesis is based on congenital deficiency of the enzyme C21-hydroxylase, which is involved in the synthesis of androgens in the adrenal cortex. For a long time, the deficiency of this enzyme can be compensated by the body, and the first symptoms of the disease often occur only under the influence of triggers that stimulate the adrenal glands to work harder. These triggers primarily include severe emotional stress, the onset of sexual activity or pregnancy, which quite often ends in miscarriage. At the same time, the following changes occur in the ovaries:

• amenorrhea occurs due to suppression of growth and maturation of follicles in the early stages of folliculogenesis;
• anovulation or oligomenorrhea - due to inhibition of growth and maturation of the follicle and egg;
• inferiority of the corpus luteum – due to the occurrence of insufficiency of the luteal phase.

Regardless of what kind of changes occur in the ovaries as a result of adrenal hyperandrogenism, a characteristic clinical picture develops with the leading symptom – infertility.

Clinical presentation of the classical form of adrenal hyperandrogenism

Depending on the severity of C21-hydroxylase enzyme deficiency, three main forms of adrenogenital syndrome are distinguished: classical, pubertal and post-pubertal. The classic form of adrenogenital syndrome of adrenal origin occurs as a result of congenital adrenal hyperplasia. At the same time, characteristic clinical signs appear already at the birth of a girl – she has a pathological development of the external genital organs, which is regarded as false hermaphroditism. Therapeutic tactics in the classical form of adrenogenital syndrome is selected separately in each case of the disease.

What are the symptoms of the pubertal form of adrenal hyperandrogenism

Very often, adrenal hyperandrogenism occurs in puberty, as a result of hormonal changes in the body. At the same time, the following symptoms come to the fore in the clinical picture:

• menstrual irregularities – menarche in such girls occurs at the age of 15-16, then the menstrual cycle is irregular, there is a tendency to oligomenorrhea;
• hirsutism is pronounced: there is increased hair growth on the face, along the white line of the abdomen, on the inner surface of the thighs;
• skin manifestations: with hyperandrogenism, the skin is oily and porous, multiple acne and extensive hyperpigmentation spots are observed;
• body changes: girls with hyperandrogenism have pronounced masculine features of the body structure, such as broad shoulders, narrow pelvis, after the appearance of hirsutism, hypoplasia of the mammary glands occurs.

Disorders of reproductive function in post-pubertal form of hyperandrogenism

If adrenal hyperandrogenism occurs in the post-pubertal period – reproductive disorders come to the fore. Often, such women experience pregnancy, which ends with an early termination, after which studies are carried out to determine the hormonal state of the body. Hirsutism in the post-pubertal form of adrenogenital syndrome is slightly expressed, there is scanty hair growth along the white line of the abdomen and single hairs above the upper lip. The physique is no different from that of healthy women, the mammary glands are developed normally. The severity of menstrual disorders depends on the degree of deficiency of C21-hydroxylase: from anovulatory cycles to miscarriage as a result of inferiority of the corpus luteum.