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Endocrinology and Metabolism Clinics of... Sep 1993Hyperandrogenism must be considered in any girl with premature pubarche, unusual acne, hirsutism, or androgenetic alopecia. An association with menstrual irregularity or... (Review)
Review
Hyperandrogenism must be considered in any girl with premature pubarche, unusual acne, hirsutism, or androgenetic alopecia. An association with menstrual irregularity or obesity should raise the index of suspicion. The most common causes of hyperandrogenism presenting in a teenage girl are functional ovarian hyperandrogenism, one manifestation of which is polycystic ovary syndrome, and functional adrenal hyperandrogenism, which usually seems to be due to an exaggeration of adrenarche. The plasma-free testosterone is a more sensitive indicator of hyperandrogenism than is the total testosterone concentration. The pattern of response of plasma free testosterone, DHEAS, and cortisol to dex-suppression testing can be diagnostic of the source of androgen excess. Treatment, including oral contraceptives, low-dose glucocorticoids, and antiandrogens, should be chosen according to the patient's symptoms and source of androgens and should be combined with traditional therapy for the specific dermatologic disorder.
Topics: Acne Vulgaris; Adolescent; Alopecia; Androgens; Female; Hirsutism; Humans; Hyperandrogenism
PubMed: 8243445
DOI: No ID Found -
European Review For Medical and... Sep 2023There is insufficient data on which cut-off value must be used to measure the increase in total testosterone (TT) compared to the upper limit of normal (CULN) in the...
OBJECTIVE
There is insufficient data on which cut-off value must be used to measure the increase in total testosterone (TT) compared to the upper limit of normal (CULN) in the diagnosis of androgen-secreting tumor (ASTM) in female individuals with premenopausal hirsutism (FIPH).
PATIENTS AND METHODS
A total of 413 FIPH over 18 years of age who were admitted to the endocrinology clinic between May 2013 and 30 April 2018 were eligible for the study. Hormone profiles of the participants in the follicular phase and other information were obtained from their files. The androgen suppression ratio (ASR) was analyzed after 48 hours of low-dose dexamethasone suppression test (LDDST) in those whose TT CULN (nmol/L) increased two-fold.
RESULTS
Idiopathic hirsutism was found in 193 participants (46.73%) and polycystic ovary syndrome (PCOS) in 200 (48.43%) and other sources of hirsutism; non-classical congenital adrenal hyperplasia (NCCAH) in 10 patients (2.42%), hyperprolactinemia in 6 patients (1.45%), ASTM of ovarian origin in 2 patients (0.48%), Cushing's disease in 1 patient (0.24%), and adrenal ASTM in 1 patient (0.24%). A cut-off value of two-fold CULN increase for TT sensitivity of 100% and a specificity of 99.5% in indicating an ASTM source, and ASR above 49% in LDDST sensitivity of 80% and a specificity of 100% in excluding an ASTM source, was used.
CONCLUSIONS
At the TT level, a two-fold increase CULN in FIPH indicates an ASTM source. In addition, ASR after LDDST is a useful parameter in the exclusion of ASTM sources in the same patient population.
Topics: Humans; Female; Adolescent; Adult; Testosterone; Androgens; Hirsutism; Testosterone Congeners; Neoplasms
PubMed: 37782181
DOI: 10.26355/eurrev_202309_33791 -
Gynecologic and Obstetric Investigation 1986Hyperandrogenism may result in acne and hirsutism. On the other hand, acne and hirsutism may occur without elevated androgen serum levels. An important point of androgen...
Hyperandrogenism may result in acne and hirsutism. On the other hand, acne and hirsutism may occur without elevated androgen serum levels. An important point of androgen action is the target organ sensitivity at the receptor level. In the present study, androgen receptor (AR) determinations by saturation analysis were performed in 36 hirsute as well as in 11 female and 52 male acne patients. A small group of endocrine healthy patients served as control group. For AR analysis, the predilection sites of the disease were chosen. In acne, also nonlesional skin served as control. 26% of the hirsute patients were AR-positive, with mean AR levels of 68 fmol/mg protein. Male acne patients were 50% AR-positive in acne lesions and 60% positive in their nonlesional skin. The mean AR levels were 25 and 38 fmol/mg protein, respectively. The control group was 27% AR-positive, with mean AR levels of 15 fmol/mg protein. Female acne patients were 3/11 positive in lesional and 1/11 positive in nonlesional skin. The mean AR levels were 25 and 35 fmol/mg protein, respectively. The female control group was in 3/13 cases AR-positive, with a mean level of 8 fmol/mg protein. Comparison of the AR levels indicates hirsutism as the mostly androgen-dependent dermatosis. No correlation between AR and androgen serum levels was demonstrated. This finding suggests that androgen action at the target organ level in both dermatoses may be independent of peripheral serum levels of hormones.
Topics: Acne Vulgaris; Adult; Androgens; Cytosol; Female; Hirsutism; Humans; Male; Receptors, Androgen
PubMed: 2950033
DOI: 10.1159/000298915 -
Gynakologische Rundschau 1991
Review
Topics: 3-Oxo-5-alpha-Steroid 4-Dehydrogenase; Alopecia; Androgen-Insensitivity Syndrome; Androgens; Female; Hirsutism; Humans; Male; Receptors, Androgen; Virilism
PubMed: 1790999
DOI: No ID Found -
Hematology (Amsterdam, Netherlands) Dec 2022Whether combined CsA with androgen therapy was superior to androgen therapy alone in NSAA remains controversial. This study aimed to assess the efficacy and safety of... (Meta-Analysis)
Meta-Analysis
The efficacy and safety of cyclosporine A plus androgen versus androgen alone for adult patients with non-severe aplastic anemia in China: a meta-analysis of randomized controlled trials.
BACKGROUND
Whether combined CsA with androgen therapy was superior to androgen therapy alone in NSAA remains controversial. This study aimed to assess the efficacy and safety of combined therapy versus androgen therapy for NSAA patients using a meta-analytic approach.
METHODS
An electronic database of PubMed, EmBase, Cochrane library, CNKI, VIP, and Wanfang was systematically searched for randomized controlled trials (RCTs) from their inception to February 2020. The primary endpoint was effective rate, while the secondary endpoints included white blood cell (WBC), hemoglobin, platelet, and potential adverse events. The pooled results from included trials were calculated with the random-effects model.
RESULTS
Forty-three RCTs recruited 2610 NSAA patients for the final quantitative meta-analysis. We noted that combined therapy was associated with an increased incidence of effective rate than androgen therapy alone (relative risk [RR]: 1.35; 95% confidence interval [CI]: 1.29-1.41; < 0.001). Moreover, patients treated with combined therapy were associated with higher WBC (weighted mean difference [WMD]: 1.22; 95%CI: 0.94-1.49; < 0.001), hemoglobin (WMD: 12.93; 95%CI: 8.86-17.01; < 0.001), and platelet (WMD: 8.65; 95%CI: 7.05-10.24; < 0.001). Finally, the pooled incidence of hirsutism, handshake, gingiva hyperplasia, liver function damage, and renal function damage were 0.35 (95%CI: 0.22-0.48), 0.24 (95%CI: 0.15-0.32), 0.22 (95%CI: 0.10-0.35), 0.19 (95%CI: 0.14-0.25), and 0.06 (95%CI: 0.01-0.11), respectively.
CONCLUSIONS
This study found that combined CsA with androgen therapy was superior to androgen therapy alone for Chinese patients with NSAA, and the most common adverse of combined therapy included hirsutism, handshake, gingiva hyperplasia, liver function damage, and renal function damage.
Topics: Adult; Androgens; Anemia, Aplastic; Cyclosporine; Hirsutism; Humans; Hyperplasia; Randomized Controlled Trials as Topic
PubMed: 35688457
DOI: 10.1080/16078454.2022.2081008 -
Der Hautarzt; Zeitschrift Fur... Oct 2020Hyperandrogenism or hyperandrogenemia are medical conditions characterized by excessive levels of androgens in the periphery or systemically. Clinical manifestations of... (Review)
Review
Hyperandrogenism or hyperandrogenemia are medical conditions characterized by excessive levels of androgens in the periphery or systemically. Clinical manifestations of hyperandrogenism include hirsutism, seborrhea, acne, androgenetic alopecia, and virilization. Hirsutism, defined as excessive growth of terminal hair in women in a male-like pattern, is the most commonly used clinical diagnostic criterion of hyperandrogenism and is determined by using a standardized scoring system of hair growth. Acne and alopecia are further common androgenic skin changes and might be observed without hirsutism in some women. Clitoris hypertrophy, increase of muscle mass, irregular menstrual cycle, and metabolic syndrome can also accompany this condition. Among others polycystic ovary syndrome (PCOS), Cushing disease, and late-onset adrenogenital syndrome belong to the most frequent causes of hyperandrogenemia. Virilization is a relatively uncommon feature of hyperandrogenemia and its presence often suggests an androgen-producing tumor. Management of symptoms include the use of antiandrogens such as cyproterone acetate, spironolactone, and flutamide. A thorough history, a focused clinical examination and an interdisciplinary approach together with gynecologists and endocrinologists are extremely helpful in the diagnostic evaluation and therapy of patients with suspected hyperandrogenism.
Topics: Acne Vulgaris; Alopecia; Androgens; Female; Hirsutism; Humans; Hyperandrogenism; Polycystic Ovary Syndrome
PubMed: 32857168
DOI: 10.1007/s00105-020-04677-1 -
The Journal of Clinical Endocrinology... Apr 2019In 46,XY disorders of sexual development (DSD) patients, several factors may affect psychosexual development, leading to gender identity discrepancy and gender change...
CONTEXT
In 46,XY disorders of sexual development (DSD) patients, several factors may affect psychosexual development, leading to gender identity discrepancy and gender change later in life. Prenatal sexual steroid exposure and external genital virilization are considered to influence human psychosexual development, but their roles not completely understood yet.
DESIGN
A total of 144 individuals (18 to 60 years of age) with a clinical/molecular diagnosis of 46,XY DSD from a single tertiary center were enrolled. Psychosexual outcomes (gender role, gender identity, and sexual orientation) were assessed using questionnaires and psychological test. The Sinnecker score was used for genital virilization measurement. Prenatal androgen exposure was estimated according to 46,XY DSD etiology.
RESULTS
We found a positive association between prenatal androgen exposure and male psychosexual outcomes. Alternatively, prenatal estrogen exposure, age of gonadectomy, and the degree of external genital virilization did not influence any psychosexual outcome. There were 19% (n = 27) with gender change, which was associated with prenatal androgen exposure (P < 0.001) but not with the external genital virilization. The median age of gender change was 15 years, but most of the patients reported the desire for gender change earlier.
CONCLUSIONS
Prenatal androgen exposure influenced psychosexual development in 46,XY DSD favoring male psychosexuality in all psychosexual outcomes, whereas the degree of external genital virilization did not influence these outcomes. The organizational effect of sexual steroids on psychosexuality at puberty appears to be weak in comparison with the prenatal effects. Prenatal androgen exposure also influenced female-to-male gender change frequency. All 46,XY DSD conditions with prenatal androgen exposure must be followed for gender issues in their management.
Topics: Adolescent; Adult; Androgens; Disorder of Sex Development, 46,XY; Female; Gender Identity; Humans; Male; Middle Aged; Pregnancy; Prenatal Exposure Delayed Effects; Retrospective Studies; Sex Reassignment Procedures; Sexual Behavior; Sexual Development; Virilism; Young Adult
PubMed: 30388241
DOI: 10.1210/jc.2018-01866 -
Current Opinion in Endocrinology,... Dec 2022To explore the recent updates in the diagnosis, management, and clinical implications of androgenic alopecia among patients diagnosed with polycystic ovarian syndrome... (Review)
Review
PURPOSE OF REVIEW
To explore the recent updates in the diagnosis, management, and clinical implications of androgenic alopecia among patients diagnosed with polycystic ovarian syndrome (PCOS).
RECENT FINDINGS
PCOS diagnosis continues to be the most common cause of infertility among reproductively aged women, serving as the most common endocrinopathy among this population. Female pattern hair loss (FPHL) has been seen to be associated and more common among patients with PCOS, however, there are limited studies examining the impact of FPHL among PCOS patients. Although hyperandrogenism is associated with FPHL, the pathophysiology continues to be unclear as FPHL can be present with normal biochemical androgen markers. Treatment can be complex, as common treatments to promote hair growth can exacerbate undesired hirsutism, which can be overcome by cosmetic treatments. New second-line treatment options such as low level laser therapy and platelet rich plasma have been emerging, with limited data supporting efficacy.
SUMMARY
PCOS is a complex endocrinological disorder that has significant gynecologic, cutaneous, and metabolic implications that require multidisciplinary collaboration and care. Reproductive goals should be thoroughly discussed prior to starting any treatment, as PCOS is the most common cause of infertility among reproductively-aged women.
Topics: Female; Humans; Aged; Hirsutism; Polycystic Ovary Syndrome; Androgens; Hyperandrogenism; Alopecia; Infertility
PubMed: 36226726
DOI: 10.1097/MED.0000000000000777 -
The New England Journal of Medicine Dec 2005
Review
Topics: Adult; Algorithms; Androgen Antagonists; Androgens; Contraceptives, Oral, Combined; Diagnosis, Differential; Female; Hirsutism; Humans; Hyperandrogenism; Hypertrichosis; Polycystic Ovary Syndrome; Practice Guidelines as Topic; Testosterone
PubMed: 16354894
DOI: 10.1056/NEJMcp033496 -
Human Reproduction Update 2010Hirsutism is the presence of excess body or facial terminal (coarse) hair growth in females in a male-like pattern, affects 5-15% of women, and is an important sign of... (Review)
Review
BACKGROUND
Hirsutism is the presence of excess body or facial terminal (coarse) hair growth in females in a male-like pattern, affects 5-15% of women, and is an important sign of underlying androgen excess. Different methods are available for the assessment of hair growth in women.
METHODS
We conducted a literature search and analyzed the published studies that reported methods for the assessment of hair growth. We review the basic physiology of hair growth, the development of methods for visually quantifying hair growth, the comparison of these methods with objective measurements of hair growth, how hirsutism may be defined using a visual scoring method, the influence of race and ethnicity on hirsutism, and the impact of hirsutism in diagnosing androgen excess and polycystic ovary syndrome.
RESULTS
Objective methods for the assessment of hair growth including photographic evaluations and microscopic measurements are available but these techniques have limitations for clinical use, including a significant degree of complexity and a high cost. Alternatively, methods for visually scoring or quantifying the amount of terminal body and facial hair growth have been in use since the early 1920s; these methods are semi-quantitative at best and subject to significant inter-observer variability. The most common visual method of scoring the extent of body and facial terminal hair growth in use today is based on a modification of the method originally described by Ferriman and Gallwey in 1961 (i.e. the mFG method).
CONCLUSION
Overall, the mFG scoring method is a useful visual instrument for assessing excess terminal hair growth, and the presence of hirsutism, in women.
Topics: Androgens; Female; Hair; Hirsutism; Humans; Polycystic Ovary Syndrome
PubMed: 19567450
DOI: 10.1093/humupd/dmp024