Androgen Excess in Women: Experience with Over 1000 Consecutive Patients

Abstract

The objective of the present study was to estimate the prevalence of the different pathological conditions causing clinically evident androgen excess and to document the degree of long-term success of suppressive and/or antiandrogen hormonal therapy in a large consecutive population of patients. All patients presenting for evaluation of symptoms potentially related to androgen excess between October 1987 and June 2002 were evaluated, and the data were maintained prospectively in a computerized database. For the assessment of therapeutic response, a retrospective review of the medical chart was performed, after the exclusion of those patients seeking fertility therapy only, or with inadequate follow-up or poor compliance. A total of 1281 consecutive patients were seen during the study period. Excluded from analysis were 408 patients in whom we were unable to evaluate hormonal status, determine ovulatory status, or find any evidence of androgen excess. In the remaining population of 873 patients, the unbiased prevalence of androgen-secreting neoplasms was 0.2%, 21-hydroxylase-deficient classic adrenal hyperplasia (CAH) was 0.6%, 21-hydroxylase-deficient nonclassic adrenal hyperplasia (NCAH) was 1.6%, hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome was 3.1%, idiopathic hirsutism was 4.7%, and polycystic ovary syndrome (PCOS) was 82.0%. Fifty-nine (6.75%) patients had elevated androgen levels and hirsutism but normal ovulation. A total of 257 patients were included in the assessment of the response to hormonal therapy. The mean duration of follow-up was 33.5 months (range, 6-155). Hirsutism improved in 86%, menstrual dysfunction in 80%, acne in 81%, and hair loss in 33% of patients. The major side effects noted were irregular vaginal bleeding (16.1%), nausea (13.0%), and headaches (12.6%); only 36.6% of patients never complained of side effects. In this large study of consecutive patients presenting with clinically evident androgen excess, specific identifiable disorders (NCAH, CAH, HAIRAN syndrome, and androgen-secreting neoplasms) were observed in approximately 7% of subjects, whereas functional androgen excess, principally PCOS, was observed in the remainder. Hirsutism, menstrual dysfunction, or acne, but not alopecia, improved in the majority of patients treated with a combination suppressive therapy; although more than 60% experienced side effects.

Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome

“…To exclude 21-hydroxylase deficiency in patients with a 17-hydroxyprogesterone (17-HP) level above 6 nmol/l, 17-HP levels stimulated by adrenocorticotropic hormone (ACTH) were measured (23,24). In brief, all tests were started between 0800 and 0900 h with the patients in the fasting state.…”

The Prevalence of Non-classical Congenital Adrenal Hyperplasia Due to 21-hydroxylase Deficiency in Greek Women with Hirsutism and Polycystic Ovary Syndrome

“…Evaluating the basic values of 17-OHP, 4 women out of 107 (3.73%) were We have focused on 21-OHdef because it is known as one of the more frequent enzyme deficiencies in the group of the disorders of CAH, presenting as common as 90%-95% of the cases [1,2,6,12]. The frequency of NC-CAH due to 11b-OHdef and NC-CAH due to 3b-HSDdef among patients with hyperandrogenemia is very low (lower than 1% of the cases) [32,33] but it is possible that a very small number of patients with the previously reported enzyme deficiencies in the rest of our patient population with PCOS would be diagnosed if these enzyme deficiencies were investigated. The determination of HLA phenotypes of these 10 women with NC-CAH revealed the phenotypes B 14, DR 1 , B 35 , B 7 and B44 in high frequency, in agreement with the literature.…”

Polycystic Ovary Syndrome in Adolescence

“…Polycystic ovaries occur in about one-third of these, however [80], and the adrenal rests of the ovaries that can occur in this condition may be difficult to distinguish from PCOS [55]. Androgen-secreting tumors of the ovaries or adrenal glands occur in only about 0.2% of cases [81], but many are malignant. Those with only moderate androgen elevations have indolent presentations resembling PCOS [82].…”