In recent years, humanity has been facing serious health problems. Incomprehensible symptoms that lead to confusion are often signs of an oncological process. Most of them are benign. With timely detection and treatment of unpleasant symptoms, you can lose once and for all. What should doctors pay attention to if there is a woman at the reception? What symptoms can indicate hormonal disorders in the female body? What is hyperandrogenism?
Hyperandrogenism – a clinical syndrome that represents a set of typical clinical manifestations of an increased content of androgens in the peripheral blood / or an increase in their activity.
What are the main symptoms of hyperandrogenism?
Manifestations can range from mild defiminization to overt visualization. Defiminization is hirsutism without biochemical signs of hyperandrogenism. Symptoms of androgenism include damage to the hair follicles and sebaceous glands, reproductive disorders (amenorrhea and infertility). With an increase in testosterone, a certain peripheral effect is observed - manifestations of androgen-dependent dermopathy.
Main manifestations of hyperandrogenism:
1. Acne - damage to the hair follicles and sebaceous glands, as a result of clogging of the excretory ducts. Physiologically, acne occurs during puberty. Acne in women over 20 may indicate hyperandrogenism. However, there was no correlation between the severity of acne and the level of testosterone hormone. The presence of acne in young women after 20 years of age is almost half caused by polycystic ovary syndrome.
2. Seborrhea - increased secretion by the sebaceous glands due to the excessive influence of androgens. This process extends to the scalp, face and neck. Possible manifestations on the back and chest. Seborrhea is a favorable factor in the development of acne.
3. Alopecia. Any hair follicle has its own life rhythm, which consists of periods of rest and growth. Follicles respond differently to androgen levels. So, in the parietal, frontal and temporal region, hair follicles are more sensitive to male hormones. In these areas, the terminal hairs undergo involution to short, fine, vellus-type hairs, followed by shedding. As a result, the vessels near the follicle spasm, which does not allow normal processes and blood circulation to function.
As a result, the follicles die and androgenetic alopecia is formed. Alopecia indicates a prolonged and high level of androgen production. Such a pronounced alopecia is observed with a virilizing tumor (androgen-producing). Androgenetic alopecia – the main symptom of a severe course of hyperandrogenism. This is the basis for further diagnosis in order to look for stromal tecomatosis or a tumor of the adrenal glands or ovaries that secrete androgens. In other parts of the body, androgen overproduction is manifested by the development of hirsutism.
4. Hirsutism is manifested by excessive hair growth in women in areas that are dependent on androgens. This occurs as a consequence of the long-term influence of excess androgens on the hair follicles. As a result, terminal hair grows out of vellus hair (rod, pigmented and hard). The severity of hirsutism does not always depend on the degree of biochemical hyperandrogenism.
Virilization is a clear sign of excessive androgen excess. In the medical literature there is a term "virile syndrome". This concept refers to the rapid defiminization and formation of male traits. Virilization occurs in less than 1% of women who have hirsutism. A common cause of viril syndrome is tecomatosis of the ovaries or adrenal glands. This tumor produces androgens in large quantities.
Causes of hyperandrogenism
Hyperandrogenism may indicate some diseases. Mild hyperandrogenism is often accompanied by polycystic ovary syndrome. Causes of androgenism:
• Decreased production of a transport protein that binds the biologically active form of testosterone.
• Increased secretion of androgenic fractions.
• Increased conversion of less active to more active androgen fractions in peripheral tissues.
What examinations will help confirm or refute hyperandrogenism?
If the patient has obvious symptoms of hormone hypersecretion, it is advisable to determine the concentration of these hormones. In the presence of virilization, clarification of the source of a possible tumor is required. To do this, use MRI or ultrasound of the pelvic organs and CT of the adrenal glands. In case of an accidental finding, treatment should not be immediately prescribed. This is just an excuse for further laboratory examination of the patient and confirmation of the diagnosis.
One of the main diagnostic criteria is an increase in androgens in the peripheral blood, primarily testosterone.
In the blood of women, dihydrotestosterone is formed from testosterone intracellularly, which means that it is not informative to determine it in the peripheral blood. The most sensitive method for detecting testosterone is tandem mass spectrometry. However, this method is still inaccessible in clinical practice. Evaluation of fractions of biologically active testosterone is effective by enzyme immunoassay (ELISA).
What is iatrogenic hyperandrogenism and how can I avoid it?
When differentiating the diagnosis of endogenous hyperandrogenism, it is necessary to find out whether the patient took exogenous androgens and anabolic steroids, as well as glucocorticosteroids and antigonadotropic drugs (danazol).
Some progestogens have androgenic potential. Interferons, sedatives and cyclosporins can provoke abundant hair growth, up to hypertrichosis. They have no effect on androgen metabolism. When gels containing androgens are used by sexual partners of women (for the treatment of hypogonadism in men), this may cause exogenous hyperandrogenism in women. Because when the skin and mucous membranes of a woman come into contact with the skin of a partner where the drug was applied, diffusion of androgens occurs. As a result, the concentration of testosterone in the blood increases significantly.
Treatment of hyperandrogenism is carried out depending on the severity and characteristics of the organism. Often, hormonal drugs are used for this ( Diane-35, Androkur, glucocorticosteroids). If a tumor is detected, surgical treatment is recommended.
Thus, it is possible to suspect such a hormonal disorder as hyperandrogenism already at the first meeting with the patient. And it is extremely important to pay attention to these suspicions, since hyperandrogenism, in addition to cosmetic and aesthetic defects, is a terrible threat to a woman - infertility. Early detection and treatment will save a woman from the serious consequences of hyperandrogenism.
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