National consensus on the management of patients with hyperandrogenism (2016)
Keywords:hyperandrogenism, hirsutism, acne, polycystic ovary syndrome, androgen, a national consensus
Hyperandrogenism is the most common endocrinopathy in women caused by excessive production of androgens by the ovaries and/or adrenal glands or increased local tissue sensitivity to circulating androgens. Frequent characteristic of its manifestations are dermopathy (acne, alopecia, seborrhea and hirsutism), and polycystic ovary syndrome. In addition hyperandrogenism may show impaired reproductive function in women, such as ovulatory disorder, infertility and miscarriage.
Causes of hyperandrogenism are:
• increase synthesis of androgens by the ovaries and/or adrenal glands;
• increased conversion of testosterone into a more active form dihydrotestosterone due to increased 5α-reductase activity;
• reduction of globulin that binds sex steroids;
• increased sensitivity of sebaceous glands receptors and hair follicles to androgens;
• using drugs with androgenic effect.
The severity and allocation of hirsutism determined by the modified scale Gallery-Ferryman, with the estimation of hair growth in 9 body areas that sensitive to androgen, each of which is measured at point scale. To assess the severity of acne is considered the most appropriate combined approach, whereby the determined nature and prevalence of acne items and calculated their number.
A current European standard of laboratory hyperandrogenism diagnosis is evaluation free testosterone by liquid chromatography, but in Ukraine its concentration determines by enzyme immunoassay, which is not sufficiently effective. Also the most informative laboratory parameters in the diagnosis of hyperandrogenism that recommended by the European Endocrine Society includes free testosterone index and androstenedione.
Differential diagnosis involves the exclusion of thyroid diseases, hyperprolactinemia and nonclassical forms of congenital adrenal dysfunction.
Pathogenetic therapy of hyperandrogenism manifestations include:
• dermopathy treatment;
• normalization of hormonal profile and menstrual function;
• protection from endometrial hyperplasia (hyperestrogenemia against the anovulation background);
• reliable contraception when using antiandrogens and systemic retinoids;
• metabolic disorders correction;
• infertility treatment.
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