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The pathological manifestation in humans of the pronounced characteristics inherent in the opposite sex is often provoked by adrenal hyperandrogeny (adrenogenital syndrome). With the development of this syndrome in the body, there is a high content of androgens (steroid male sex hormones), leading to virilization.
Virilization (masculinization) of the adrenal genesis is caused by excessive production of androgenic hormones by the adrenal glands and leads to external and internal changes that are atypical for the patient's sex. Androgens are necessary in the body of an adult woman, since they are responsible for the important transformations of the body in the process of puberty. In particular, they produce estrogen synthesis, as well as contribute to the strengthening of bone tissue, muscle growth, are involved in the regulation of the liver and kidneys and the formation of the reproductive system. Androgens are produced mainly by the adrenal glands and in the female body by the ovaries, and in the male, respectively, by the testes. A significant excess of the normal content of these hormones in women can significantly upset the reproductive system and even provoke infertility.
Causes of adrenal hyperandrogenism
The main reason for the accumulation of androgens in the body is a congenital defect in the synthesis of enzymes that prevents the conversion of steroids. Most often, the deficiency of C21-hydroxylase, which synthesizes glucocorticoids, acts as such a defect. In addition, hormonal imbalance is a consequence of the influence of hyperplasia of the cortical layer of the adrenal glands or tumor-like formations (some types of adrenal tumors are capable of producing hormones). The most commonly diagnosed presence of adrenal hyperandrogenism of the congenital type. However, sometimes there are cases of development of hyperandrogenism due to adrenal tumors secreting androgens (Itsenko-Cushing's disease).
C21-hydroxylase deficiency is able to be successfully compensated for some time by the adrenal glands and goes into decompensated phase during stress fluctuations of the hormonal background, which are created by emotional shocks and changes in the reproductive system (onset of sexual relations, pregnancy). When the defect in the synthesis of enzymes becomes pronounced, the conversion of androgens into glucocorticoids stops and they are excessively accumulated in the body.
Features of the development of adrenogenital syndrome in women
Adrenogenital syndrome in women leads to serious changes in the functioning of the ovaries and disorders in the reproductive system. According to statistical studies, every fifth woman suffers to some extent from hyperandrogenism with various manifestations. Moreover, age in this case does not matter, the disease manifests itself at any stage of the life cycle, starting from infancy.
The impact of hyperandrogenism on ovarian function causes the following manifestations:
- inhibition of growth and development of follicles in the early phase of folliculogenesis is manifested by amenorrhea (absence of menstruation for several cycles),
- a slowdown in the growth and development of the follicle and ovum, which is not capable of ovulation, can be manifested by anovulation (lack of ovulation) and oligomenorrhea (an increase in the interval between menstruations),
- ovulation with a defective corpus luteum is expressed in insufficiency of the luteal phase of the cycle, even with regular menstruation.
Symptoms of adrenal hyperandrogenism
Adrenogenital syndrome has primary and secondary manifestations, depending on the phase of the disease and its causes. Indirect signs of the presence of adrenal hyperandrogenism in women are frequent colds, a tendency to depression, and increased fatigue.
The main symptoms of adrenal hyperandrogenism:
- increased hair growth (limbs, abdomen, mammary glands), up to hirsutism (hair growth on the cheeks),
- baldness with formation of bald patches (alopecia),
- skin defects (acne, acne, desquamation and other inflammations),
- muscle atrophy, osteoporosis.
The secondary symptoms of adrenogenital syndrome are the following manifestations:
- hypertension, manifested in the form of seizures,
- elevated blood glucose (type 2 diabetes),
- rapid weight gain, up to obesity in need of therapy,
- intermediate type of formation of female genital organs,
- lack of menstruation or significant intervals between periods,
- infertility or miscarriage (for the safe course of pregnancy, a certain amount of female hormones in the body, the production of which practically stops in the event of hyperandrogenism).
Adrenal hyperandrogenism is a serious pathology that can lead to significant complications. With congenital hyperandrogenism, abnormalities of the genital organs occur. Disorders of the reproductive system can lead to miscarriage, the chronic inability to bear the fruit, infertility. With hyperandrogenism resulting from adrenal tumors, there is a risk of developing malignant tumors and metastasis.
Diagnostic measures to identify adrenal hyperandrogenism include laboratory tests and instrumental examination methods. Laboratory tests include blood and urine tests for steroid hormones and their breakdown products. Sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI) are used as imaging examinations to detect tumor-like formations.
Therapy of adrenogenital syndrome
Treatment of adrenal hyperandrogenism is primarily aimed at normalizing the hormonal background and eliminating the external negative manifestations of hormonal imbalance. An increased level of androgens in the body is neutralized with the help of drugs that increase the amount of female-type hormones (for example, Dexamethasone, Metipret).
Hormone therapy in women directly depends on the patient’s plans for the future. If a woman does not plan to conceive a child, then oral contraceptives are prescribed with an anti-androgenic effect (for example, "Janine", "Ioannina"). Oral contraceptive “Diane-35”, which is prescribed in conjunction with the drug “Androkur” to enhance the effect, is useful for eliminating skin manifestations. However, the result will appear only after three months of therapy. In the case of pregnancy planning, drugs are activated that activate the release of the egg. In the absence of a therapeutic effect, surgical intervention is possible in the form of a wedge-shaped resection of the ovaries in order to stimulate the release of the egg. As well as surgical intervention is indicated in the presence of adrenal tumors (tumors must be surgically removed).
As folk remedies for the regulation of hormonal background, herbs are used. There is a mass of plants that have a beneficial effect on metabolic processes and contribute to the normalization of hormonal balance (dengil, spike grass, licorice root, peppermint, evading peony, pristnyak sacred, etc.). However, the use of herbal remedies is possible only as an addition to medical therapy; it is impossible to eliminate the pathology with folk remedies.
Varieties and causes of the syndrome
The process of maturation of androgens occurs in the ovaries and adrenal glands. The normal amount of the hormone produced and its correct ratio to estrogen provides the hormonal balance necessary for the full functioning of the body.
Depending on the origin of the pathology, there are several of its forms:
- Hyperandrogenism of ovarian genesis - occurs with polycystic ovary syndrome. The reason is a malfunction of the hypothalamus-pituitary system. The violation is hereditary.
- Hyperandrogenism of the adrenal genesis is caused by a malfunction of the adrenal cortex. The disease is congenital and may also be caused by tumors (Itsenko-Cushing disease). In this case, the first menses begin late, with scanty secretions, and with time they may stop altogether. Other characteristic signs are an abundance of acne in the back and chest, an underdevelopment of the mammary glands, the formation of a male-type figure, an increase in the clitoris.
A number of patients are diagnosed with hyperandrogeny of mixed genesis. In this case, the body simultaneously disrupted the functioning of the ovaries and adrenal glands. This pathology is caused by hypothalamic and neuroendocrine disorders. Disruptions in the hormonal balance are aggravated by vegetative neurotic disorders. In some cases, mild hyperandrogenism is diagnosed, in which the androgen parameters are normal, and ultrasound does not detect the presence of tumors in the internal organs.
Mixed form prevents the onset of pregnancy and makes it impossible to successfully bear a child.
Given the degree of exceeding the permissible level of androgens, they distinguish the absolute and relative form of the adrenogenital syndrome. In the first case, the concentration of male hormones exceeds the permissible norms. Relative hyperandrogenism is diagnosed with acceptable indicators of male hormones. At the same time, they note an increased sensitivity of the organs and glands of a woman to their effects.
Summarizing, we can identify the following main causes of this syndrome:
- improper production of a special enzyme that synthesizes androgens, resulting in their excessive accumulation in the body,
- the presence of adrenal tumors,
- diseases and failures in the ovaries, causing excessive production of androgens,
- thyroid pathology (hypothyroidism), pituitary tumors,
- long-term use of steroids during professional occupations of power sports,
- childhood obesity,
- genetic predisposition.
With disruption of the ovaries, an increase in the adrenal cortex, hypersensitivity of skin cells to the effects of testosterone, tumors of the genital and thyroid glands may develop pathology in childhood.
Congenital hyperandrogenism sometimes does not allow an accurate determination of the sex of the newborn child. The girl may have large labia, enlarged to the size of the penis clitoris. 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 is 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.
In 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 menses.
Symptoms can range from minor (excessive hair growth on the body) to severe (development of secondary male sexual characteristics).
Clinical manifestations of hyperandrogenism in women in the form of acne and male-type hair distribution
The main manifestations of pathological disorders are:
- Acne - occurs when the skin is oily, which leads to blockage and inflammation of the sebaceous glands,
- seborrhea of the scalp,
- hirsutism - the appearance of strong hairiness in places atypical for women (face, chest, abdomen, buttocks),
- thinning and loss of hair on the head, the appearance of bald patches,
- increased muscle growth, male-shaped muscle formation,
- coarseness of voice,
- violation of the menstrual cycle, scarcity of discharge, sometimes complete cessation of menstruation,
- increased libido.
The ongoing disruptions in the hormonal balance cause the development of diabetes mellitus, the appearance of excess weight, and lipid metabolism disorders. Women become very susceptible to various infectious diseases. They often develop depression, chronic fatigue, irritability and general weakness.
One of the most serious consequences of hyperandrogenism is virilization or viril syndrome. So called the pathology of the development of the female body, in which it acquires pronounced male symptoms. Virilization refers to rare abnormalities, it is diagnosed only in one patient out of 100 who have excessive hair growth on the body.
A woman forms a male figure with enhanced muscle growth, monthly periods stop completely, the size of the clitoris increases significantly. Very often, these symptoms develop in women who take steroids uncontrollably to increase stamina and physical strength in sports.
Diagnosis of the pathological condition includes an external and gynecological examination of the patient, the analysis of her complaints of general well-being. Pay attention to the duration of the menstrual cycle, the localization of excessive hairiness, body mass index, the appearance of the genitals.
What tests need to be taken to determine the level of androgens?
Doctors (gynecologist, endocrinologist, geneticist) prescribe the following studies:
- determining the level of testosterone, follicular hormone, prolactin, estradiol in the blood and cortisol in the urine,
- samples with dexemethasone to determine the cause of the development of the syndrome,
- Ultrasound of the ovaries and adrenal glands,
- CT pituitary,
- studies of glucose, insulin, cholesterol.
Ultrasound of the pelvic organs will determine the possible presence of polycystic ovaries. Testing is needed to set up a type of disease.
Materials for research taken in the morning, before meals. Since hormones are unstable, three samples are taken for accurate diagnosis with interruptions for at least half an hour. It is advisable to take tests in the second half of the menstrual cycle, closer to the expected beginning of menstruation.
Principles of therapy
Treatment of hyperandrogenism should be complex and, first of all, aimed at eliminating problems and diseases that act as provoking factors. The list of such diseases includes thyroid disease, polycystic ovary syndrome, adrenogenital syndrome.
The choice of treatment methods depends on the form of pathology and the goal pursued by therapy (the fight against hirsutism, the restoration of reproductive function, the preservation of pregnancy with the threat of miscarriage).
The main therapeutic measures include:
- drug therapy
- surgical intervention,
- use of traditional medicine,
- normalization of nutrition and physical activity.
It is used to reduce the amount of male hormones produced and to block the processes that contribute to their excessive activity. The presence of tumors in the genital organs, causing ovarian hyperandrogenism, is eliminated by surgical intervention.
If a woman is not planning a pregnancy in the near future, but suffers from acne and excessive hair on her body, oral contraceptives with anti-androgenic effects are prescribed (for example, Diane 35) to get rid of these symptoms.
Such drugs not only eliminate unpleasant external signs, but also contribute to the normalization of the menstrual cycle. For the cosmetic effect, anti-inflammatory ointments are prescribed that reduce sebum production.
In the presence of contraindications to the use of contraceptives for the treatment used Spironolactone. It is prescribed for severe premenstrual syndrome and polycystic ovaries. The drug successfully treats acne and excessive hair growth.
Analogue drug is Veroshpiron. Its main active ingredient is also spironolactone. Acceptance of Veroshpiron is extremely undesirable without consulting the doctor about the duration of use and the required dosage.
If hypreandrogenism is caused by the lack of an enzyme that turns androgens into glucocorticoids, means are shown that normalize this process. The drug Metipred is very effective. Forms of its release - tablets and powders for injections. The tool is contraindicated in the presence of infectious and viral diseases, tuberculosis, heart failure. The duration of treatment and dosage is determined by the doctor.
Drugs used to treat hyperandrogenism
One of the successful methods of 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 additional psychological discomfort to the woman.
Общее количество калорий, употребляемых ежедневно, не должен превышать 2000. В этом случае, при достаточной физической активности, количество потребляемых калорий будет ниже расходуемых, что и приведет к постепенному снижению веса.
The diet shown in 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. Useful jogging, aerobics, swimming, active games in the fresh air.
Hirsutism is controlled using various cosmetic procedures: waxing, depilation, removal of unwanted hair with a laser.
The use of traditional medicine
Treatment with folk remedies is quite applicable in the complex of drug therapy, but it is not a complete replacement for traditional methods.
- Herbs of clover, sage, meadowsweet and knotweed are mixed in equal parts, pour 200 ml of water, keep in a water bath for 20 minutes and filter. To the resulting broth add 1.5 ml of tincture of Rhodiola Rosea. Take a decoction in a third glass a few times a day before meals.
- 2 tablespoons of the crushed train, 1 spoon of yarrow and motherwort pour boiling water, insist about an hour, filter. Take half a cup on an empty stomach in the morning and before bedtime.
- A few tablespoons of dried nettle leaves is poured with a glass of water, drawn in a closed container, filtered. Take several times a day for a tablespoon.
- Rosehips, black currant poured boiling water, insist about an hour. Then add some honey. 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 - boron uterus. It is used in conjunction with other therapeutic agents in the form of a decoction or tincture.
- 100 g of pine forest uterus pour 500 ml of vodka and infuse for 2 weeks. Tincture take 0.5 teaspoon three times a day.
- 2 tablespoons of boron uterus pour a glass of boiling water, leave for about an hour. Drink in small portions throughout the day.
- 100 g of peeled green nuts and boron uterus mixed 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 for half an hour before eating.
To reduce the amount of androgens produced, mint is used. Based on it, prepare tinctures and teas. For greater efficiency, milk thistle can be added to the mint. Normalizes female hormonal balance regular intake of green tea.
How to treat a problem with herbs and combine this method with other types of treatment, always tell the attending physician. Do not self-medicate!
Hyperandrogenism and Infertility
Excessive androgen production often becomes an obstacle to the desired pregnancy.
How to get pregnant with the help of drug therapy and how realistic is it?
Infertility treatment in this case is aimed at using drugs that stimulate the release of an egg from the ovaries. An example of such a drug may be clomiphene.
One of the most effective drugs used to stimulate ovulation and normalize the menstrual cycle is Duphaston. After pregnancy, taking the drug continues to prevent miscarriage and normalize the development of pregnancy.
If the stimulation is ineffective, doctors advise to resort to surgical treatment. Modern medicine widely uses the method of laparoscopy. During this procedure, excision of the ovaries is performed to help the “exit” of the mature egg. The probability of getting pregnant after laparoscopy is the higher, the less time passes from the day of surgery. The maximum ability to conceive is noted in the first three months.
But even after a successful conception, the presence of hyperandrogenism can interfere with successful childbearing. An excess of male hormones often leads to the fact that the fertilized egg can not be kept in the uterus. The probability of miscarriage remains high.
Dangerous weeks of pregnancy with hyperandrogenism is the period up to 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 save the pregnancy, the patient is prescribed Dexamethasone (metipred). It helps to reduce the level of androgen. The dosage of the drug selects only a doctor!
Many future mothers are very afraid of the side effects of the drug and fear that it may harm the unborn baby. Years of experience with this drug proves its safety, both for the development of the unborn child, and for the flow of the childbirth.
In most cases, to avoid the risk of miscarriage, doctors advise you to first complete a full course of treatment, and then plan a pregnancy. If a woman fails to conceive a child, IVF is possible.
There are no specific measures for the prevention of hyperandrogenism, since this syndrome develops on a hormonal level.
Common preventive measures include:
- a balanced diet that includes foods rich in fiber, weight control,
- smoking cessation and alcohol abuse
- regular visits to the gynecologist,
- taking drugs and contraceptives only after the recommendation of a doctor,
- timely treatment of pathologies of the thyroid gland, diseases of the liver and adrenal glands.
Hyperandrogenism is not only a problem with the skin, hair and menstrual cycle. This is a common disease of the body that does not allow a woman to lead a quality lifestyle and often deprives her of the joys of motherhood. Modern methods of diagnosis and treatment allow time to identify pathology and successfully eliminate its manifestations.
The essence of the disease
When it comes to such diseases as hyperandrogenism in women, the causes of symptoms, treatment and preventive measures are always associated with such a problem as the effect of adrogens on the body. This process leads to the appearance in the female appearance of male traits 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 pathology develops
The topic “hyperandrogenism in women: causes, symptoms, treatment” is very important for women, 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 - adrenogenital syndrome can be determined. The bottom line is that the adrenal glands are capable of producing many other hormones besides adrogens, for example, glucocorticoids. The latter appear under the influence of a certain enzyme. The basis for their occurrence are accumulated androgens. Sometimes women already have an enzyme defect at birth, with the result that male hormones are not transformed, but accumulate on an ongoing basis, causing unpleasant changes in the female body.
There is one more process due to which hyperandrogeny of adrenal genesis develops. We are talking about tumors of the adrenal glands. They are also formed on the background of increasing concentrations of androgens.
The risk of developing the pathology mentioned above also arises when male hormones are produced in a woman’s ovaries. Moreover, cells that produce adrogens can cause tumors to form in the ovaries.
Hyperandrogenism syndrome is sometimes the result of the effects of pathologies of other endocrine organs, such as the pituitary gland.
Signs of excess androgen
If we talk about the clinical symptoms of increased concentrations of the male hormone, then they can be described as follows:
- hair loss and bald areas in the forehead (arogenic alopecia),
- sebaceous glands begin to produce an excessive amount of secretion, resulting in oily skin increases,
- baryphony, which means lowering the voice,
- hair appears on the belly 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 such a disease, some women may have menstrual disorders, a complete absence of menstruation, as well as myocardial hypertrophy, obesity, infertility and hypertension.
Concentration of male hormones can cause an increase in the susceptibility of the female body to infections of various types. It is also possible fatigue and a tendency to depression.
Acne and sebaceous glands
To clearly understand what to do with such a problem as hyperandrogenism in women, causes, symptoms, treatment and diagnosis should be considered thoroughly. Since the factors causing the development of the disease were discussed above, it makes sense to study the features of the symptoms.
If we deal with such a problem as acne, it is worth noting that they are the result of keratinization of the follicle walls and increased sebum production, which is stimulated by the concentration of androgens, including in plasma. With such symptoms, as a rule, COCs or antiandrogens are prescribed, which allows to significantly improve the patient's condition.
Also under the influence of male hormones in the androgen-dependent zones appear pigmented, thick, coarse hair instead of fluffy. This usually occurs during puberty. At the same time, the effect of androgen on the area of eyebrows, eyelashes, temporal and occipital parts remains minimal.
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 is reduced to the fact that the pathology is congenital and makes itself felt against the background of the androgenital syndrome. It leads to a critical decrease in the female body of the level of enzymes necessary for the production of such hormones as glucocorticoids.
Hyperandrogenism of the adrenal genesis is caused by this deficiency, which leads to an increase in the concentration of other hormones - pregnenolone, progesterone, etc. Such changes end with an increased production of androgen in the female body.
Sometimes pathology is diagnosed, which was caused by adrenal tumors that secrete the male hormone. According to statistics, such a form of the disease as adrenal hyperandrogenism is recorded in 30-50% of women with androgen problems.
Impact on the ovaries
A high concentration of male hormones can affect the functioning of the ovaries. In most cases, this problem makes itself felt through two forms: hypertecosis and polycystic. It is important to pay attention to the fact that the risk of the development of this pathology in women increases with regular exercise sports.
Ovarian hyperandrogenism is a consequence of slowing the growth of follicles under the influence of androgens. Since they consist of the ovaries, the result of such processes is the fusion of the latter. The medical name for this problem is follicular atresia.
But this is not all the complications that accompany ovarian hyperandrogenism. The bottom line is that the male hormone plays the role of a factor, against the background of which the pathological formation of fibrous connective tissue develops, which leads to polycystic. In this situation, the good news is the fact that only 5% of women face this problem.
It is also worth noting that this form of hyperandrogenism in the weaker sex is the cause of the failure of the central regulation of the level of androgens. This process occurs at the level of the hypothalamus and pituitary gland. As a result, hormonal changes significantly.
Signs that are worth paying attention to
There are a number of symptoms that indicate the appearance of the problem described above. The fact that there is such a pathology as hyperandrogenism of the ovaries of genesis can be recognized by the following manifestations:
- on the face, in addition to acne, there is scaling and inflammation, which are difficult to neutralize by usual cosmetological methods,
- excess weight,
- changing the proportions of the female body - masculinization,
- voice hardening (baryphony),
- hair growth all over the body, even on the face,
- formation of bald patches on the head.
In addition, there are still many secondary symptoms, such as an increase in blood glucose levels, arterial hypertension, low immunity, etc.
Ovarian hyperandrogenism as described above may cause obesity in women. In this form of pathology, an increase in estradiol levels 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 forming under its influence have the most direct influence on the development of obesity, corresponding to the male type.
Such processes are the cause of increased insulin dependence and the 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.
Doctors with a certain periodicity 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 what is dangerous hyperandrogenism in women. In essence, what happens is this: adrenal androgens, concentrating in the adrenal glands, thereby increasing the level of the male hormone in the ovaries. This process occurs in the blood, which leads to increased production of luteinizing hormone. The latter, in turn, provokes the appearance of hyperandrogenic syndrome.
The emergence of a mixed form of pathology can be caused by severe injuries, brain intoxication or a pituitary tumor.
Hyperandrogenism is too serious a problem to ignore the help of qualified medical professionals. And if we analyze the entire course of treatment, we can conclude that it is aimed at achieving 4 key goals:
- elimination of skin manifestations
- normalization of the menstrual cycle
- infertility treatment, which was caused by anovulation,
- elimination and prevention of metabolic disorders associated with the underlying disease.
Diet for hyperandrogenism in women is prescribed in the 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 met, you can get the desired result.
Those patients who intend to have a child, in most cases, are prescribed hormone therapy, which is able to provide full-fledged ovulation.
Women who are not planning a pregnancy are treated with oral contraceptives, and in some cases wedge-shaped excision of the ovaries.
Preparations for treating hyperandrogenism in women are also actively used if the body is not able to neutralize a high level of androgen on its own. We are talking about such means as "Metipred", "Dexamethasone" and others. Surgery can be prescribed in the event that the pathology is triggered by a tumor.
A high concentration of the male hormone in the female body is more than a serious problem, which often develops against the background of no less dangerous diseases. Therefore, when the first symptoms appear, diagnosis and treatment must be carried out without fail.
The concept of hyperandrogenism
Naturally, a completely healthy woman has an androgen in the body, but it is present in small quantities. In the same case, when the development takes place too intensively, therapy should help come, leveling the negative actions. These hormones perform many important functions:
- Impact on puberty processes.
- Thanks to androgens, hair is formed in the pubic and armpit areas.
- Regulates the activity of the kidneys and liver.
- Promote the growth of muscle mass.
- Help develop and maintain the functions of the reproductive system.
In the same case, if too many androgens enter the blood stream from the ovaries, adrenal glands or adipocytes, where they are produced, for a woman the manifestations of this can turn out extremely negative. Reproductive function is suppressed, which is expressed in the absence of menstruation and, as a result, infertility. This can be explained by the specific effect of male sex hormones on the ovaries. First of all, they androgens prevent the formation and normal maturation of follicles. Помимо этого, они становятся причиной появления большого количества кист яичников.
Надпочечниковая гиперандрогения у женщин возникает по причине неправильного функционирования надпочечников, а точнее, их коры. In most cases, this pathology is congenital. Another possible cause is the appearance of neoplasms. Symptoms of this problem may be the following:
- Monthly discharge from girls begins at a later age. From the very beginning they are extremely scarce, and over time they can stop.
- There is a strong acne rash, concentrated in the chest and back.
- The mammary glands are small and underdeveloped.
- The figure of the girl in proportions becomes masculine.
- Clitoris increased in size.
This disease can occur against the background of incorrect selection of androgens not only by the adrenal glands, but also by the ovaries. In this case, treatment is required against the background of polycystic ovary syndrome. As a rule, this problem is mainly hereditary. This pathology appears due to the fact that the woman lost the connection between the pituitary and the hypothalamus. Often this happens, adrenal hyperandrogenism exists in the female body in conjunction with the ovarian, in which there is a violation in the work of both organs. For women, this means an obstacle to the normal conception of the baby, and to its bearing.
In order to better understand the degree of development of the disease in a particular woman, doctors use the concept of hyperandrogenism of two types:
- Absolute. In this case, only the fact that the androgen rate is exceeded and what the deviation is is taken into account.
- Relative. The number of male hormones in a woman’s blood may not exceed the norm, but all systems and organs of the body show increased sensitivity to them.
Causes of hyperandrogenism
In a brief form, the causes of hyperandrogeny of adrenal and ovarian genesis are as follows:
- The enzyme that “calls” the glands to produce androgens is produced in the body incorrectly, and therefore androgens are produced with excess and accumulate in the blood, causing unpleasant symptoms.
- Various tumors appear in the adrenal glands.
- Ovaries suddenly fail, which increases the production of male hormones.
- Pathologies in the functioning of the thyroid gland, called hypothyroidism, or tumors in the pituitary gland.
- For athletes, the use of steroid hormones can be a similar nuisance. The longer the reception took, the stronger the consequences may be.
- In childhood, little attention was paid to proper nutrition, which led to early obesity.
- Heredity plays a significant role.
In some cases, which include, for example, an increase in the cortical layer of the adrenal glands, tumors of the glands or malfunction of the ovaries, treatment may be needed as early as childhood. In the same case, when hyperandrogeny is a congenital defect, doctors can sometimes have difficulty determining the sex of the infant. At a time when the internal genitals are completely normal, the external ones are very much like boys: the clitoris is enlarged to such an extent that it resembles the penis, and the labia also abnormally large.
Symptoms of hyperandrogenism
Depending on how much the process of pathological changes in the body is started, the symptoms in different patients differ in the severity of their manifestations. For some, it is possible to limit oneself to hair growing in places unusual for the given sex, while others begin to show full-fledged secondary male signs, but treatment is required in both cases. Adrenal hyperandrogenism can manifest itself as follows:
- The fat content of the skin increases, causing the sebaceous glands to become clogged. Because of this, there is a disease with the mysterious, but the well-known name acne.
- The hair on the head is covered with dandruff. Scientifically, this problem is called seborrhea.
- As mentioned above, hair grows abundantly in places where they should not be. On the head, the hair, on the contrary, becomes very brittle and falls out strongly, balding hair gradually appears.
- Muscle tissue grows like yeast, and it is especially intense in places common to men.
- The voice becomes low and rough, like a man.
- Menstrual flow will decrease, it will not appear regularly, and in some cases it may stop altogether.
- Attraction to the opposite sex increases.
- A woman often begins to suffer from infectious diseases due to the increased susceptibility of the body to them.
- There is irritability, a tendency to depression. Already after the morning awakening, weakness and fatigue are felt.
Often, ovarian and adrenal hyperandrogenism causes diabetes or obesity, or both. All because of the fact that there are violations in the lipid and carbohydrate metabolism of the patient.
What is hyperandrogenism?
This pathological condition is often accompanied by amenorrhea (absence of menstruation) and, accordingly, infertility. The ovarian follicles are surrounded by cellular layers, and too many androgens impede follicular growth, resulting in foliar growth overgrowth - follicular atresia. A complication of the disease is fibrosis of the ovarian capsules and polycystic disease, respectively.
Before understanding the causes of pathology, its symptoms and treatment, you need to familiarize yourself with some of the concepts:
- The hypothalamus is the central regulatory department of the brain, which controls all metabolic processes in the body, is responsible for the function of the sexual and endocrine glands, it interacts with two systems - hormonal and nervous,
- The pituitary gland - the main gland of the endocrine system, is localized in the brainstem, is responsible for hormonal metabolism,
- Violations of central origin - deviations in the regulation function, occur due to a malfunction of the pituitary and / or hypothalamus,
- The adrenal glands are paired endocrine glands, localized above the kidneys, consist of the inner medulla and the outer cortical,
- The test for determining the source of the disease using dexamethasone is a procedure that allows to determine the concentration of androgens in the female body.
This form of the disorder is diagnosed in about 5% of women of reproductive age.
The reasons that pathologists can provoke are quite a large number, so it is not always possible to determine exactly what led to the failure.
However, experts in this area have determined that the main triggering factor is dysfunction of the hypothalamic-pituitary system. Such violations lead to increased production of LH or deviations in the ratio of LH / FSH.
Excessive amounts of LH lead to hyperplasia of the granular and outer layer of the follicles, the connective protein membrane of the ovaries. As a result, the number of androgens produced by the ovaries increases, and the first symptoms of masculinization appear. Lack of FSH affects the follicles: they can not mature. As a result, women develop annulation - a pathology requiring treatment.
- Relative / unconditional excess of PH due to dysfunction of the hypothalamus or adenohypophysis,
- Excessive production of androgens by the adrenal cortex during puberty,
- Obesity at puberty. Excess fat is a major risk factor because androgens are converted into estrogens,
- Hyperinsulinemia, insulin resistance,
- Violation of the genesis of steroids in the ovaries,
- Primary hypothyroidism is a lack of thyroid hormones.
Polycystic ovaries can develop against the background of atypical congenital adrenal hyperplasia. Other causes include hypertecosis, leidigoma, and androgen-secreting ovarian tumors that require surgical removal.
Symptoms and treatment of signs of hyperandrogenism
- Active hair growth on the limbs and other parts of the body (mammary glands, abdomen) in women. When hair grows on cheeks, they talk about hirsutism,
- The appearance of bald patches on the head (alopecia - hair loss),
- Cosmetic problems with the face - acne, acne, peeling, various inflammations. Treatment at the beautician does not give results,
- Osteoporosis, muscular atrophy,
- Increased blood glucose concentration (type 2 diabetes),
- Severe obesity
- Formation of genital organs by intermediate type
- The cycle has long intervals or no menses at all.
- Infertility, miscarriage (if the disease appeared during pregnancy). For successful childbirth, the body needs a certain amount of female sex hormones, and when it is ill, they are practically not produced,
- Attacks of arterial hypertension.
Sick women have a tendency to depression, they quickly get tired. It is worth noting that the disease can occur at any age, starting from the very birth.
How to identify hyperandrogenism syndrome
First of all, the physician must exclude diseases that may become provoking factors: hepatic pathologies, acromegaly, Cushing's syndrome, androgen-secreting adrenal tumors, sexual differentiation. The physician must give direction to the clinical laboratory to determine the primary hormone.
Find out the concentration of prolactin, total and free testosterone, androstenedione, FSH, dehydroepiandrosterone sulfate. For analysis, you will need to donate blood. Take it in the morning on an empty stomach. Since the hormonal background in patients is almost always changing, the samples are taken three times with an interval of 30 minutes, then all the taken portions of the blood are mixed. If more than 800 μg% of dehydroepiandrosterone sulfate is detected, then an adrenal tumor occurs.
It is also necessary to pass a urine analysis for the concentration of ketosteroids-17.
In addition, it is necessary to take the CG marker if symptoms of the disease are present, but the concentration of androgens remains within the normal range.
Instrumental examination: the patient should be referred for MRI, CT, intravaginal ultrasound to detect tumors.
It should be noted that therapy largely depends on the wishes of the patient. For example, if she plans to have children in the future, then treatment with clomiphene is provided. If she does not want to restore fertile functions, hormonal therapy with oral contraceptives is prescribed.
Two months after the start of such treatment, the concentration of testosterone and androstenedione returns to the normal range. If taking contraceptives for any reason is contraindicated, spironolankton is prescribed, which is taken for six months.
In the presence of ovarian tumors resort to surgery.
Take care of your health, do not let the disease take its course, and be sure to contact your doctor for professional help!
Why does hyperandrogenism develop?
- Hyperandrogenism can develop due to the presence of tumors on the ovaries that produce these hormones. Other diseases of the ovaries, in which male sex hormones are produced in large quantities, can provoke such a condition.
- Hyperandrogenism of the adrenal glands may develop, the symptoms of which will differ slightly. Hyperandrogenism of the adrenal genesis develops due to the presence of tumors formed in the adrenal cortex, as well as the detection of adrenogenital syndrome.
- This condition may occur due to the presence of pathologies of the pituitary or hypothalamus.
- Violations can be several, most often reveal the pathology of the adrenal glands and ovaries, as well as diseases of the pituitary gland and tumors on the ovaries.
What symptoms may appear?
Adult women may have:
- gynecological problems, in particular, infertility, polycystic ovarian disease and menstrual disorders,
- manifestations of a cosmetic nature, which include the formation of acne, baldness and hirsutism,
- metabolic disorders that can trigger the formation of diabetes mellitus, rapid weight gain and dyslipidemia,
- manifestations of male traits, namely, a low voice appears and the shoulders are modified.
The disease in girls appears gradually, with signs of hirsutism. Due to the rapid growth of bones in the early stage of the disease, children grow short in the future.
Causes of pathology
What is hyperandrogenism and why does it occur? The main causes of the disease are:
- tumors, metastases of the adrenal glands,
- violation of the hypothalamic-pituitary regulation caused by injuries, tumors, inflammatory diseases of the brain,
- ovarian tumors: luteoma, tech,
- Androgenital syndrome - a congenital pathology of the adrenal cortex, in which there is an increased production of testosterone.
In women, the causes of hyperandrogenism cause a violation of the hormonal balance, the functioning of the reproductive system, and metabolic processes in the body.
Symptoms of ovarian hyperandrogenism
The disease can be of ovarian and adrenal genesis - depending on the organ, which begins to produce vigorously androgens. Ovarian hyperandrogenism in most cases develops on the background of polycystic ovary syndrome, less often hormone-producing tumors cause pathology.
PCOS is characterized by menstrual disorders, infertility, and increased levels of androgens in the blood. The girl's figure changes according to the male type, the hair begins to grow on the face and body, the volume of the waist and chest increases, and the fat layer is deposited in the lower abdomen. Work of sebaceous glands is broken, seborrhea, acne, which is not treatable, appears. On the skin of the thighs, buttocks appear stretch marks. Sleep apnea (breath holding) leads to insomnia.
In the photo a woman with characteristic signs of hirsutism.
The characteristic symptoms of hyperandrogenism in PCOS are the appearance of premenstrual syndrome. Women become irritable, their mood often changes, they are worried about migraine, intense abdominal pain, swelling, tenderness of the mammary glands.
Ovaries 2-3 times increase in size, their capsule thickens. Inside the body, multiple cystic formations are found. Hormonal imbalance causes thickening and hyperplasia of the endometrium of the uterus, menses become longer, more abundant, with the release of blood clots.
Mixed type of hyperandrogenism
Hyperandrogenism of mixed genesis is manifested by symptoms of the ovarian and adrenal forms of the disease. Polycystic ovary and signs of androgenital syndrome are found in women.
Manifestations of a mixed type of disease:
- high blood pressure
- violation of the menstrual cycle, amenorrhea,
- cysts in the ovaries,
- infertility, early termination of pregnancy,
- impaired glucose tolerance or high blood sugar,
- elevated levels of low density lipoprotein.
Hyperandrogenism can cause systemic diseases that affect the adrenal cortex, the ovaries or the brain, impair metabolism. These are pituitary adenomas, anorexia nervosa, schizophrenia, type 2 diabetes mellitus, acromegaly, prolactinoma.
Peripheral and central hyperandrogenism
With damage to the central nervous system, inflammatory, infectious diseases or intoxication of the body, the secretion of pituitary gonadotropic hormones, which are responsible for the production of luteinizing and follicle-stimulating hormone, can be suppressed. As a result, the process of maturation of the follicle in the ovary and the synthesis of sex hormones is disturbed, androgen production increases.
Symptoms of polycystic, ovarian dysfunction, menstrual disorders, skin rashes, PMS are found in women.
Peripheral hyperandrogenism is caused by the increased activity of the skin enzyme, the sebaceous glands of 5-α-reductase, which converts testosterone to the more active androgen dihydrotestosterone. This leads to hirsutism of varying severity, the appearance of acne vulgaris.
Hyperandrogenism during pregnancy
In pregnant women, increased levels of androgens cause spontaneous abortion. The most dangerous dates are the first 7–8 and 28–30 weeks. Intrauterine hypoxia of the fetus is observed in 40% of patients, most often it occurs in the third trimester. Another complication is late toxicosis, thus deteriorating kidney function, increasing blood pressure, swelling of the body.
Hyperandrogenism during pregnancy can lead to premature discharge of amniotic fluid, complicated labor. Changes in hormonal levels adversely affect the development of the child, cerebral circulation may be impaired in infants, and there are signs of intrauterine hypotrophy.
Hyperandrogenism and pregnancy are causes of urgent hormone therapy to prevent abortion and other complications. Women who have previously had miscarriages, miscarriage, increased levels of male hormones, should be carefully examined at the planning stage of pregnancy.
Для восстановления гормонального баланса женщинам рекомендуется регулярно заниматься умеренными физическими нагрузками, отказаться от вредных привычек, вести здоровый образ жизни. Важно придерживаться режима питания, составить сбалансированную диету, исключающую кофе, алкоголь, углеводы, животные жиры. It is useful to eat fresh fruits, vegetables, dairy products, dietary meats and fish. To compensate for the deficiency of vitamins take pharmaceutical preparations.
Treatment of folk remedies can be carried out only in conjunction with the main therapy. You should first consult a doctor.
Hyperandrogenism causes disturbances in the work of many organs and systems, leads to the development of adrenal and ovarian failure, infertility, and type 2 diabetes. To prevent the occurrence of symptoms of hirsutism, skin rashes, metabolic syndrome, hormone therapy is indicated.