Hyperandrogenism

Hyperandrogenism is a clinical and biological syndrome secondary to an increase of secretion of androgens. These androgens can be produced by the cortex of the adrenal gland in its inner layer, the reticularis; by the ovary in the theca of the ovarian follicle, the stroma or the hilus Leydig cells; and in some cases, as in the PCOS, both in the ovary and in the adrenal gland.

Hyperandrogenism is a clinical and biological syndrome secondary to an increase of secretion of androgens. The androgens can be produced by the cortex of the adrenal gland in its inner layer, the reticularis; by the ovary in the theca of the ovarian follicle, the stroma or the hilus Leydig cells; and in some cases, as in the PCOD, both in the ovary and in the adrenal gland.

This hyperandrogenism has particular clinical and biological findings which can be isolated. Or it can be associated with clinical and biological findings of virilization.

In clinical practice:

The adrenal or ovarian origin of these syndromes can be difficult to determine, leading sometimes to venous catheterization of the adrenal and the ovarian veins.

The etiology, functional or tumoral, can be difficult to assess.

As the ovarian etiologies are discussed in three different chapters of the book (Chaps. 7, 11, and 13), it seemed to us interesting to report in a chapter of synthesis the main clinical and biological findings of these syndromes, the site of secretion and the biochemistry of the synthesis in the different compartments of the ovary, and the overview of the most frequent etiologies.

14.1 Biosynthesis of Adrenal and Ovarian Androgens

Biosynthesis of adrenal and ovarian androgens is reported in the biochemistry chapter (Chap. 3).

14.2 Clinical and Biological Findings

The clinical and biological findings of hyperandrogenism without virilization are reported in Table 14.1.

Table 14.1

Clinical and biological findings of hyperandrogenism

1. Clinical findings

Related to hyperandrogenism: hirsutism, acne, seborrhea

Related to ovulatory dysfunction: oligomenorrhea, amenorrhea, sterility

Related to insulinoresistance syndrome: diabetes, acanthosis nigricans

2. Biological findings

Delta 4 androstenedione significantly increased

Testosterone slightly increased

The clinical and biological findings of hyperandrogenism with virilization are reported in Table 14.2.

Table 14.2

Clinical and biological findings of virilization

1. Clinical findings

Clitoromegaly

Hoarse voice

Androgyne morphotype

2. Biological findings

Testosterone >200 ng/ml

Delta 4 androstenedione proportionally less increased

14.3 Etiology

The causes of hyperandrogenism without virilization are mainly functional in origin, while most of the hyperandrogenism with findings of virilization (except hyperthecosis of the ovary) are tumoral in origin. The etiologies of these entities may lie mainly in the ovary and the adrenal gland (or the hypophysis which secretes ACTH). The most common ones are reported in Table 14.3.

Table 14.3

Etiology of hyperandrogenism

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