Hormonal disease of hyperandrogenism of ovarian genesis. Treatment of the syndrome of hyperandrogenism and PCOS Pathological csk hyperandrogenism

Hyperandrogenism of ovarian genesis is a pathology during which a systemic failure occurs in the hormonal background of a woman. The cause of the disease is the active production of the male hormone (androgen), which exceeds the permissible norms.

Androgen production in women is carried out by the ovaries. This hormone is responsible for puberty, during which the reproductive function is fully formed. Hair appears in the groin, armpits, some girls have facial hair. Androgen is an integral regulator of the liver, adrenal glands, and genital organs.

Androgen is necessary for the full functioning of the female body. Excessive production threatens to turn into serious complications that need to be promptly treated with drug therapy, and, if necessary, surgical intervention.

Hyperandrogenism of ovarian genesis is characterized by serious disturbances in the functioning of the genital organs. Against the background of the disease, girls begin to grow hair intensively on the face, chest, abdomen, puberty is formed (as a result of a lack of female hormone), hyperplasia of the connective tissue protein membrane of the ovaries occurs.

The disease requires emergency assistance from the side of medicine. Otherwise, the consequences are irreversible.

Reasons for development

Ovarian hyperandrogenism develops in the following cases:

• excessive physical activity;
• an increased amount of androgen - a male hormone;
• lack of LH, which occurs as a result of malfunctions in the hypothalamus;
• fullness, overweight. From a medical point of view, obesity can trigger androgens, which are found directly in fat. They mutate, adapt to female body and are transformed into estrogens;
• with the second type diabetes.

Most often, young girls during puberty, as well as women after 45 years of age, are exposed to the disease (the moment of menopause leads to serious pathological changes in the body).

Symptoms

Among obvious signs hyperandrogenism, one can distinguish a sharp growth of hair in uncharacteristic places (for example, on the chin). Let's look at the rest of the symptoms:

• the appearance of hair on the abdomen, arms, legs and even thighs. Among all the varieties of the disease, it is worth noting one - hirsutism. The hairline is actively developing on the face;
• the development of a primordially male disease - baldness;
• the maxillofacial apparatus undergoes changes. The face becomes rougher, purulent neoplasms, darkening or acne are present on the skin. Speech changes, voice timbre changes. A visit to a beauty salon does not bring results;
• muscles weaken.

You should also consider the secondary symptoms that mild hyperandrogenism of ovarian origin has:

• a tendency to diabetes is formed;
• fullness, a sharp weight gain;
• the genitals cease to develop and remain at the stage of development present before the onset of the disease;
• violation of the menstrual cycle;
• there is a complication - infertility;
• sudden pressure drops. There is a possibility of developing chronic hypertension.

Diagnostics

Ovarian hyperandrogenism is fairly easy to diagnose. Sometimes a visual inspection is enough to determine the presence of hairline in uncharacteristic places in order to understand what exactly is happening to a woman.

The patient is examined and questioned. The doctor (usually a gynecologist) tries to reject extraneous diseases that have similar symptoms. The following is a series of laboratory tests.

Initially, the hormonal background is measured and it is established what changes it has undergone recently. The amount of androgen produced in the body of a woman is analyzed, and after that it is compared with the norm. For more precise compilation clinical picture, the patient gives urine, in which the amount of ketosteroids-17 is measured.

If necessary, the patient is sent for examination for a detailed clinical picture, assessment of the damage caused to the body. It is worth clarifying that the disease has serious, irreversible consequences, which can be eliminated only with timely, high-quality and complete treatment.

Treatment of ovarian hyperandrogenism

As a therapeutic course, drug therapy is used. The prescribed medications will depend on the form of hyperandrogenism, as well as the individual characteristics of the patient's body.

Consider the main types of drugs used to eliminate the disease:

The diagnostic series, as well as the subsequent therapeutic drug course, should be as accurate and balanced as possible. An already weakened female body can be easily “finished off” with incorrectly prescribed drugs, which will only increase the production of androgen.

Do not delay treatment. After 2-3 months from the onset of the disease, some consequences, including the full functionality of the reproductive system, can simply not be stabilized. In addition, hairline, as well as excess weight, can persist for a long time.

Hyperandrogenism is a disorder hormonal background, characterized by excessively strong production of androgen - the male hormone. For the female body, this substance is necessary, as it performs several functions at once, but its excess entails rather unpleasant consequences, which must be treated without fail.

Androgens are produced by organs such as the adrenal glands, ovaries, and adipocytes. The process of puberty, the appearance of hair in the armpits and genitals, depends on these hormones. Androgens are involved in regulating the functioning of the kidneys and liver, affect reproductive system and muscle growth. They are also needed in adulthood, as they synthesize estrogen, maintain a sufficient level of libido and strengthen bone tissue.

What is hyperandrogenism?

This pathological condition is often accompanied by amenorrhea (absence of menstruation) and, accordingly, infertility. Ovarian follicles are surrounded by cell layers, and too much androgen interferes with follicular growth, resulting in overgrowth of follicles - follicular atresia. A complication of the disease is fibrosis of the ovarian capsules and polycystic, respectively.

Before understanding the causes of pathology, its symptoms and treatment, you need to familiarize yourself with some concepts:

1. The hypothalamus is the central regulatory department of the brain, which controls all the metabolic processes of the body; responsible for the function of the sex and endocrine glands; two systems interact in it - hormonal and nervous;
2. The pituitary gland is the master gland endocrine system; localized in the brain stem; responsible for hormonal metabolism;
3. Violations of central origin - deviations in the regulatory function; arise due to a malfunction in the pituitary gland and / or hypothalamus;
4. Adrenal glands are paired endocrine glands; localized above the kidneys; consist of an inner medulla and an outer cortical;
5. A test to determine the source of the disease using dexamethasone is a procedure that allows you to determine the concentration of androgens in the female body.

Adrenal hyperandrogenism

This form of the disease is most often congenital. Symptoms of pathology in this case appear quite early. The first menstruation appears much later than expected, and in the future they become rare or stop altogether. All patients with adrenal hyperandrogenism have abundant acne on the chest and back, as well as local pigmentation of the skin.

Symptoms of hyperandrogenism in women are:

1. underdevelopment of the mammary glands;
2. the figure develops according to the male type (narrow pelvis, broad shoulders);
3. the clitoris is slightly hypertrophied, the uterus is reduced, but there are no deviations in the development of the ovaries.

In adrenal disease, glucocorticoid therapy is required to maintain hormonal levels within normal limits.

Hyperandrogenism of ovarian origin

This form of disorder is diagnosed in about 5% of women of reproductive age.

There are a fairly large number of reasons that pathologists can provoke, so it is not always possible to determine what exactly led to the failure.

However, experts in this field have determined that the main provoking factor is dysfunction of the hypothalamic-pituitary system. Such disorders lead to increased production of LH or deviations in the LH / FSH ratio.

An excess of LH leads to hyperplasia of the granular and outer layer of the follicles, the connective protein coat of the ovaries. As a result, the amount of androgens produced by the ovaries increases, the first symptoms of masculinization appear. The lack of FSH affects the follicles: they cannot mature. As a result, women develop annovulation - a pathology that requires treatment.

Causes of hyperandrogenism

1. Relative / unconditional excess of LH due to dysfunction of the hypothalamus or adenohypophysis;
2. Excessive production of androgens by the adrenal cortex during puberty;
3. Obesity at puberty. Excess fat is a major risk factor because it converts androgens into estrogens;
4. Hyperinsulinemia, insulin resistance;
5. Violation of the genesis of steroids in the ovaries;
6. Primary hypothyroidism is a lack of thyroid hormones.

Polycystic ovaries can develop against a background of atypical congenital adrenal hyperplasia. Other causes include hyperthecosis, leidigoma, and androgen-secreting ovarian tumors that require surgical removal.

Symptoms and treatment of signs of hyperandrogenism

1. Active hair growth on the limbs and other parts of the body (mammary glands, abdomen) in women. When hair grows on the cheeks, they talk about hirsutism;
2. The appearance of bald patches on the head (alopecia - hair loss);
3. Cosmetic problems with the face - acne, pimples, peeling, various inflammations. Treatment by a cosmetologist does not give results;
4. Osteoporosis, muscle atrophy;
5. Increased blood glucose concentration (type 2 diabetes);
6. Sharp obesity;
7. The formation of the genital organs according to the intermediate type;
8. The cycle has long intervals or there are no periods at all;
9. Infertility, miscarriage (if the disease appeared during pregnancy). For the successful bearing of a child, the body needs a certain amount of female sex hormones, and in case of illness they are practically not produced;
10. Attacks of arterial hypertension.

In sick women, there is a tendency to depressive states, they quickly get tired. It is worth noting that the disease can occur at any age, starting from birth.

How to identify hyperandrogenism syndrome

First of all, the doctor must exclude diseases that can become provoking factors: hepatic pathologies, acromegaly, Cushing's syndrome, androgen-secreting tumors of the adrenal glands, sexual differentiation. The doctor must give a referral to the clinical laboratory for the determination of the main 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 in patients the hormonal background is almost constantly changing, samples are taken three times with an interval of 30 minutes, then all the taken portions of blood are mixed. If more than 800 mcg% of dehydroepiandrosterone sulfate is detected, it means that there is an adrenal tumor.

It is also necessary to pass a urine test for the concentration of ketosteroids-17.

In addition, it is necessary to take a marker of hCG if there are symptoms of the disease, but the concentration of androgens remains within the normal range.

Hyperandrogenism is a phenomenon in which a woman's body produces an excessive amount of male hormones-androgens. Their excess causes serious deviations in work. internal organs and systems. The greatest danger is for women who plan to conceive and bear a child. Ovarian hyperandrogenism causes infrequent and scanty menstruation, can cause infertility and lack of ovulation.

Hyperandrogenism is a dangerous condition in which a woman cannot conceive and bear a fetus. Due to the excess amount of male hormones in the ovaries, normal maturation of the follicles does not occur. At the same time, the female genital organ is overgrown connective tissue, because of which the egg cannot normally exit the follicles. Due to pathology, women develop serious pathologies, including polycystic ovaries: the level of insulin, anti-Müllerian hormone, testosterone, androstenedione rises in the blood. The following diseases can provoke such a disease:

• An excessive amount of LH in the blood, which arose against the background of pathologies of the hypothalamus and adenohypophysis.
• Excess production of male sex steroid hormones during the prepubertal period.
• Excess body weight, joined in the prepubertal period.
• Insulin resistance or deficiency in the body.
• Violation of the production of steroids in the female ovaries.
• Primary hormone deficiency.

Studies have shown that hyperandrogenism of ovarian origin in most cases occurs against the background of congenital pathology of the adrenal glands.

Symptoms

On initial stages diagnosing hyperandrogenism of ovarian genesis is quite difficult. This pathology does not cause any symptoms for a long time. Over time, the following symptoms appear:

• Excessive hair growth of the skin: hair appears on the abdomen, chest, cheeks.
• Alopecia on the head.
• Numerous rashes on the skin: acne, pimples, peeling.
• The development of osteoporosis - thinning of bone tissue.
• development of muscle atrophy.

You can also diagnose signs of ovarian hyperandrogenism by clinical manifestations:

• The development of type 2 diabetes - an increase in blood glucose levels.
• A sharp set of excess body weight.
• Level Up blood pressure.
• Inability to conceive a child or frequent miscarriage.
• The formation of the genital organs according to the intermediate type.

Quite often, women with hyperandrogenism experience depression and excessive fatigue. This condition can also occur in younger patients.

Diagnostics

It is quite difficult to determine ovarian hyperandrogenism - for a long time this disease does not manifest itself with any distinctive symptoms. In this case, the first signs may occur in a girl at the very beginning of puberty or upon reaching reproductive age. The earlier the pathology is diagnosed, the easier it is to get rid of it. To determine the disease, it is necessary to carry out the following studies:

• Measure your hormone levels before, during and after your period.
• Determine the level of sex hormones in the urine.
• Perform an ultrasound of the pelvic organs.
• Examine the kidneys and adrenal glands.
• Get an MRI of the internal organs.
• If necessary, laparoscopy is performed - a study that allows you to determine the nature of the cells.

Hyperandrogenism in women is a hormonal imbalance in which the concentration of male sex hormones (androgens) increases. Sex hormones are active substances that perform a regulatory function and ensure the appearance of secondary sexual characteristics and the difference between men and women.

Sex hormones play a key role in the process of human reproduction: the maturation of germ cells, pregnancy and childbirth.

Normally, a certain amount of male sex hormones circulate in the body of a woman.. However, in some cases, their concentration may exceed the permissible values, as a result of which the woman will begin to show male characteristics, and the normal functioning of the ovaries will be disrupted.

Of particular danger is the increase in the content of androgens during pregnancy. An increase in the amount of male sex hormones may be associated with their secretion in the ovaries or adrenal glands.

To normalize the hormonal balance, you can use folk remedies. Such treatment of hyperandrogenism has a mild complex effect on the body, improves metabolism and normalizes the functioning of the ovaries. In order for the therapy to be effective, it is necessary to take medicinal drugs systematically.

Hyperandrogenism is a general term for a number of endocrine pathologies of various etiologies, characterized by excessive production of male hormones - androgens in the body of a woman or increased susceptibility to steroids from target tissues. Most often, hyperandrogenism in women is first diagnosed in reproductive age - from 25 to 45 years; less often - in girls in adolescence.

Source: clinic-bioss.ru

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions.

Causes

Hyperandrogenism is a manifestation of a wide range of syndromes. Experts name the three most likely causes of hyperandrogenism:

• increased levels of androgens in the blood serum;
• conversion of androgens to metabolically active forms;
• active utilization of androgens in target tissues due to abnormal sensitivity of androgen receptors.

Excessive synthesis of male sex hormones is usually associated with impaired ovarian function. The most common is polycystic ovary syndrome (PCOS) - the formation of multiple small cysts against the background of a complex of endocrine disorders, including pathologies of the thyroid and pancreas, pituitary, hypothalamus and adrenal glands. The incidence of PCOS among women of childbearing age reaches 5-10%.

Androgen hypersecretion is also observed in the following endocrinopathies:

• adrenogenital syndrome;
• congenital adrenal hyperplasia;
• galactorrhea-amenorrhea syndrome;
• stromal tecomatosis and hyperthecosis;
• virilizing tumors of the ovaries and adrenal glands, producing male hormones.

Hyperandrogenism due to the transformation of sex steroids into metabolically active forms is often caused by various disorders of lipid-carbohydrate metabolism, accompanied by insulin resistance and obesity. Most often, there is a transformation of testosterone produced by the ovaries into dihydrotestosterone (DHT), a steroid hormone that stimulates the production of sebum and the growth of body hair, and in rare cases, hair loss on the head.

Compensatory hyperproduction of insulin stimulates the production of ovarian cells that produce androgens. Transport hyperandrogenism is observed with a lack of globulin that binds the free fraction of testosterone, which is typical for Itsenko-Cushing syndrome, dyslipoproteinemia and hypothyroidism. With a high density of androgen receptor cells in the tissues of the ovaries, skin, hair follicles, sebaceous and sweat glands, symptoms of hyperandrogenism can be observed when normal level sex steroids in the blood.

The severity of symptoms depends on the cause and form of endocrinopathy, concomitant diseases and individual characteristics.

The probability of manifestation of pathological conditions associated with the symptom complex of hyperandrogenism depends on a number of factors:

• hereditary and constitutional predisposition;
• chronic inflammatory diseases ovaries and appendages;
• miscarriages and abortions, especially in early youth;
• metabolic disorders;
• excess body weight;
• bad habits - smoking, alcohol and drug abuse;
• distress;
• long-term use of drugs containing steroid hormones.

Idiopathic hyperandrogenism is congenital or occurs during childhood or puberty for no apparent reason.

Kinds

In gynecological practice, several types of hyperandrogenic conditions are distinguished, which differ from each other in etiology, course and symptoms. Endocrine pathology can be both congenital and acquired. Primary hyperandrogenism, not associated with other diseases and functional disorders, due to violations of the pituitary regulation; the secondary is a consequence of concomitant pathologies.

Based on the specifics of the manifestation, there are absolute and relative varieties of hyperandrogenism. The absolute form is characterized by an increase in the level of male hormones in the blood serum of a woman and, depending on the source of androgen hypersecretion, are divided into three categories:

• ovarian, or ovarian;
• adrenal, or adrenal;
• mixed - simultaneously there are signs of ovarian and adrenal forms.

Relative hyperandrogenism occurs against the background of the normal content of male hormones with excessive sensitivity of target tissues to sex steroids or enhanced transformation of the latter into metabolically active forms. In a separate category, iatrogenic hyperandrogenic conditions are distinguished, which have developed as a result of prolonged use hormonal drugs.

The rapid development of signs of virilization in an adult woman gives reason to suspect an androgen-producing tumor of the ovary or adrenal gland.

Symptoms of hyperandrogenism

The clinical picture of hyperandrogenic conditions is characterized by a wide variety of manifestations that fit into the standard set of symptoms:

• disorders of menstrual function;
• metabolic disorders;
• androgenic dermopathy;
• infertility and miscarriage.

The severity of symptoms depends on the cause and form of endocrinopathy, concomitant diseases and individual characteristics. For example, dysmenorrhea manifests itself especially clearly with hyperandrogenism of ovarian genesis, which is accompanied by anomalies in the development of follicles, hyperplasia and uneven exfoliation of the endometrium, cystic changes in the ovaries. Patients complain of scanty and painful menstruation, irregular or anovulatory cycles, uterine bleeding, and premenstrual syndrome. With galactorrhea-amenorrhea syndrome, progesterone deficiency is noted.

Severe metabolic disorders - dyslipoproteinemia, insulin resistance and hypothyroidism are characteristic of the primary pituitary and adrenal forms of hyperandrogenism. Approximately 40% of patients have male-type abdominal obesity or with a uniform distribution of adipose tissue. With adrenogenital syndrome, an intermediate structure of the genitals is observed, and in the most severe cases, pseudohermaphroditism. Secondary sexual characteristics are poorly expressed: in adult women, breast underdevelopment, a decrease in the timbre of the voice, an increase in muscle mass and body hair are noted; for girls, it is typical later than menarche. The rapid development of signs of virilization in an adult woman gives reason to suspect an androgen-producing tumor of the ovary or adrenal gland.

Androgenic dermopathy is usually associated with increased activity of dihydrotestosterone. The effect of a hormone that stimulates the secretory activity of the skin glands changes the physicochemical properties of sebum, causing blockage of the excretory ducts and inflammation of the sebaceous glands. As a result, 70-85% of patients with hyperandrogenism have signs of acne - acne, dilated skin pores and comedones.

Hyperandrogenic conditions are one of the most common causes of female infertility and miscarriage.

Less common are other manifestations of androgenic dermatopathy - seborrhea and hirsutism. Unlike hypertrichosis, in which there is excessive hair growth throughout the body, hirsutism is characterized by the transformation of vellus hair into coarse terminal hair in androgen-sensitive areas - above the upper lip, on the neck and chin, on the back and chest around the nipple, on the forearms, shins and inner side of the thigh. In postmenopausal women, bitemporal and parietal alopecia are occasionally noted - hair loss at the temples and in the crown area, respectively.

Source: woman-mag.ru

Features of the course of hyperandrogenism in children

In the prepubertal period, girls may develop congenital forms of hyperandrogenism due to genetic abnormalities or exposure to androgens on the fetus during pregnancy. Pituitary hyperandrogenism and congenital adrenal hyperplasia are recognized by the pronounced virilization of the girl and anomalies in the structure of the genitals. With adrenogenital syndrome, there may be signs of false hermaphroditism: clitoral hypertrophy, fusion of the labia majora and vaginal opening, displacement of the urethra to the clitoris, and urethrogenital sinus. At the same time, there are:

• early overgrowth of fontanelles and epiphyseal fissures in infancy;
• premature body hair;
• rapid somatic growth;
• delayed puberty;
• Late menarche or no menses.

Congenital adrenal hyperplasia is accompanied by impaired water-salt balance, skin hyperpigmentation, hypotension and autonomic disorders. Starting from the second week of life, with congenital adrenal hyperplasia and severe adrenogenital syndrome, the development of an adrenal crisis is possible - acute adrenal insufficiency, associated with a threat to life. Parents should be alerted by a sharp drop in blood pressure to a critical level, vomiting, diarrhea and tachycardia in a child. In adolescence, an adrenal crisis can provoke nervous shocks.

Moderate hyperandrogenism in adolescence, associated with a sharp growth spurt, should be differentiated from congenital polycystic ovaries. The debut of PCOS often occurs at the stage of formation of menstrual function.

Congenital adrenal hyperandrogenism in children and adolescent girls can suddenly be complicated by an adrenal crisis.

Diagnostics

It is possible to suspect hyperandrogenism in a woman by characteristic changes in appearance and on the basis of anamnesis data. To confirm the diagnosis, determine the form and identify the cause of the hyperandrogenic state, a blood test is performed for androgens - total, free and biologically available testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate (DEA sulfate), and sex hormone binding globulin (SHBG).

In hyperandrogenic conditions of adrenal, pituitary and transport etiology, a woman is referred for MRI or CT of the pituitary and adrenal glands. According to indications, blood tests for 17-hydroxyprogesterone and urine tests for cortisol and 17-ketosteroids are performed. For the diagnosis of metabolic pathologies, laboratory tests are used:

• samples with dexamethasone and human chorionic gonadotropin;
• determination of the level of cholesterol and lipoproteins;
• blood tests for sugar and glycated glycogen, glucose tolerance test;
• tests with adrenocorticotropic hormone.

To improve the visualization of the glandular tissue, if a neoplasm is suspected, MRI or CT with the use of contrast agents is indicated.

Treatment of hyperandrogenism

Correction of hyperandrogenism gives a stable result only in the treatment of major diseases, such as PCOS or Itsenko-Cushing's syndrome, and concomitant pathologies - hypothyroidism, insulin resistance, hyperprolactinemia, etc.

Hyperandrogenic states of ovarian genesis are corrected with the help of estrogen-progestin oral contraceptives that suppress the secretion of ovarian hormones and block androgen receptors. With strong androgenic dermopathy, a peripheral blockade of skin receptors, sebaceous glands and hair follicles is performed.

In the case of adrenal hyperandrogenism, corticosteroids are used; with the development of the metabolic syndrome, insulin synthesizers are additionally prescribed in combination with a low-calorie diet and dosed physical activity. Androgen-secreting neoplasms are usually benign and do not recur after surgical removal.

For women planning pregnancy, the treatment of hyperandrogenism is a prerequisite for restoring reproductive function.

Prevention

Preventive gynecological examinations and screening tests to monitor androgenic status are recommended for women and adolescent girls to prevent hyperandrogenic conditions. Early detection and treatment of gynecological diseases, timely correction of hormonal levels and competent selection of contraceptives successfully prevent hyperandrogenism and help maintain reproductive function.

With a tendency to hyperandrogenism and congenital adrenopathy, it is important to adhere to healthy lifestyle life and a sparing regime of work and rest, give up bad habits, limit the impact of stress, lead an orderly sex life, avoid abortions and emergency contraception; uncontrolled intake of hormonal drugs and anabolic drugs is strictly prohibited. Equally important is the control of body weight; moderate physical activity without heavy physical exertion is preferable.

Most often, hyperandrogenism in women is first diagnosed in reproductive age - from 25 to 45 years; less often - in girls in adolescence.

Consequences and complications

Hyperandrogenic conditions are one of the most common causes of female infertility and miscarriage. Long-term hyperandrogenism increases the risk of developing metabolic syndrome and type II diabetes mellitus, atherosclerosis, arterial hypertension, and coronary heart disease. According to some reports, high activity androgen levels correlate with the incidence of some forms of breast cancer and cervical cancer in women infected with oncogenic papillomaviruses. In addition, aesthetic discomfort in androgenic dermopathy has a strong psycho-traumatic effect on patients.

Congenital adrenal hyperandrogenism in children and adolescent girls can suddenly be complicated by an adrenal crisis. Due to the possibility of a fatal outcome, at the first signs of acute adrenal insufficiency, the child should be immediately taken to the hospital.

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