Endocrine Disorders
·
Excess androgen in women :
The clinical scenario : Hyperandrogenism most often presents as hirsutism,
which usually arises as a result of androgen excess related to abnormalities of
function in the A) ovary or B) 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 clinical
evidence of too much male hormone (acne, hirsute, baldness) or Lab documentation of presence of
hyperandrogenism as established by free testosterone .Additionally , women with PCOS frequently exhibit insulin
resistance and hyperinsulinemia. 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.
How treat excess androgen
(hyper androgenaemia) :-Combination oral contraceptives (OCs) decrease adrenal
and ovarian androgen production and reduce hair growth in nearly two-thirds of
hirsute patients but not all .Because hyperinsulinemia appears to play a role
in PCOS-associated anovulation, treatement 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.
No comments:
Post a Comment