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C. Matthew Peterson
Hyperandrogenism most often presents as hirsutism, which usually arises as a result of androgen excess related to abnormalities of function in the ovary or adrenal glands. By contrast, virilization is rare and indicates marked elevation in androgen levels.
The most common cause of hyperandrogenism and hirsutism is polycystic ovarian syndrome (PCOS). There are only two major criteria for the diagnosis of PCOS: anovulation and the presence of hyperandrogenism as established by clinical or laboratory means. Patients with PCOS frequently exhibit insulin resistance and hyperinsulinemia.
Combination oral contraceptives (OCs) decrease adrenal and ovarian androgen production and reduce hair growth in nearly two-thirds of hirsute patients.
Because hyperinsulinemia appears to play a role in PCOS-associated anovulation, treatment with insulin sensitizers may shift the endocrine balance toward ovulation and pregnancy, either alone or in combination with other treatment modalities.
Excluding cases that are of iatrogenic or factitious etiology, adrenocorticotropic hormone–independent forms of Cushing syndrome are adrenal in origin. Adrenal tumors are usually very large by the time Cushing syndrome is manifest.
Congenital adrenal hyperplasia is transmitted as an autosomal recessive disorder. Deficiency of 21-hydroxylase is responsible for more than 90% of cases of adrenal hyperplasia resulting from an adrenal enzyme deficiency.
Patients with severe hirsutism, virilization, or recent and rapidly progressing signs of androgen excess require careful investigation for the presence of an androgen-secreting neoplasm. Ovarian neoplasms are the most frequent androgen-producing tumors.
Elevations in prolactin may cause amenorrhea or galactorrhea. Amenorrhea without galactorrhea is associated with hyperprolactinemia in approximately 15% of women. In patients with both galactorrhea and amenorrhea, approximately two-thirds will have hyperprolactinemia; of those, approximately one-third will have a pituitary adenoma. In more than one-third of women with hyperprolactinemia, a radiologic abnormality consistent with a microadenoma (>1 cm) is found.
● Because levels of thyroid-stimulating hormone (TSH) are sensitive to excessive or deficient levels of circulating thyroid hormone, and because most disorders of hyperthyroidism and hypothyroidism are related to dysfunction of the thyroid gland, TSH levels are used to screen for these disorders. The most common thyroid abnormalities in women, autoimmune thyroid disorders, represent the combined effects of the multiple antibodies produced. Severe primary hypothyroidism is associated with amenorrhea or anovulation. The classic triad of exophthalmos, goiter, and hyperthyroidism in Graves disease is associated with symptoms of hyperthyroidism.