Hyperandrogenism is a pathology characterized by an elevated level of androgens, i.e.male sex hormones, in the female body. As a consequence, it causes certain painful conditions. What is this phenomenon? And what consequences can there be? Let's talk about this in more detail.
- first symptoms and signs of hyperandrogenism
- disease Ovarian hyperandrogenism
- Adrenal hyperandrogenism
- pregnancy with hyperandrogenism
- Diagnostics Treatment Results
first symptoms and signs of hyperandrogenism
hyperandrogenism clinically manifested in the form of seborrhea, hirsutism, acne. It is noteworthy that in a number of cases the level of androgens can still remain within the norm. Often, hyperandrogenia causes changes in the structure of the ovaries.
Studies have confirmed that the maintenance of androgen levels in normal conditions against the background of the development of hyperandrogenism is due to the specific mechanism of the development of the disease. As a rule, this is associated with the fact that the processes of transformation of male sex hormones are changing. As a result, more active forms of hormones, for example, dihydrotestosterone, are obtained.
How is hyperandrogenism manifested?
First of all, there is hirsutism. This phenomenon is a copious hair growth in the male type in those zones that depend on the level of androgens. It is, first of all, the face, as well as the chest, abdomen, buttocks;
- Androgen-dependent alopecia is also possible. This loss of hair, in which the bald patches in the forehead are formed;
- The next external symptom is barifony, i.e.lowering the voice of the voice;
- Maskulinization is also observed in a number of cases. Masculinization is a process of changing the proportions of the female body. As a result, the humeral girdle can expand, the thigh size may decrease, and a narrow pelvis may form, and musculature develops more actively.
- Among the external signs can also be seborrhea. This phenomenon is an increased production of secret secretions from the sebaceous glands of the skin;
- Finally, there can be acne, i.e.acne.
Other symptoms characterized by hyperandrogenism are:
- malfunctions in the menstrual cycle. In some cases, amenorrhea is observed, i.e.absence of menstruation;
- anovulation. This process is characterized by the fact that the egg does not leave the ripe follicle. As a result, infertility is developing;
- hyperestrogenemia. This phenomenon is caused by an imbalance between female sex hormones. Hyperestrogenemia is at risk of developing cervical cancer;
- lowering the sensitivity of body tissues to insulin. This symptom, moreover, in itself is a prerequisite for the breakdown of carbohydrate and fat metabolism. The latter, in turn, causes diabetes mellitus type 2, obesity, the development of cardiovascular diseases and atherosclerosis.
Species of the disease
Hyperandrogenia in women has several types, which differ depending on which factor predominates in the development of the disease. Accordingly, a classification is developed that includes several clinical forms at once, the determination of which of them contributes to the selection of the most suitable technique, according to which the treatment will be carried out.
So, there are:
- central hyperandrogenism. It is spoken about when there are diseases and tumors of the pituitary gland, as well as if the hypothalamus is impaired;
- adrenal hyperandrogenism. It is associated, above all, with a tumor of the adrenal glands;
- ovarian hyperandrogenism. Polycystic and ovarian hypertecosis, as well as androgen-producing ovarian tumors, are characteristic of this species;
- mixed form. What kind of a species is it? It is caused by several violations. For example, mixed hyperandrogenism is indicated in cases of malfunctions in the functioning of the adrenal and ovaries or in the metabolic syndrome of complex genesis;
- peripheral hyperandrogenism. This variety is observed in diabetes mellitus, failures in the metabolism of fats, in the presence of hereditary contracts.
Most often there are two varieties of hyperandrogenism: adrenal and ovarian. About them and talk in more detail.
The main cause of ovarian hyperandrogenia is polycystic ovary syndrome. How does the disease manifest itself? First of all, the polycystic ovary itself is associated with a deficiency of enzymes that are contained in the ovaries. It is the hereditary deficit. It prevents the conversion of highly male androgens to female sex hormones. Accordingly, androgens accumulate, and as a result, hyperandrogenia is formed.
Ovarian hyperandrogenism is associated with the development of hormonal disorders in the hypothalamus and pituitary gland. In addition, the balance of a number of other hormones in the female body, in particular, LH, FSH, estradiol and prolactin, usually occurs.
Another cause of ovarian hyperandrogenism is androgen-producing tumors. Also, such tumors can cause a significant increase in the content of other, individually taken hormones.
Among other things, the ovarian hyperandrogenia can be mixed with the central one. A similar situation is observed due to the traumas, brain intoxications, pituitary tumors. As a result, there is a failure in physiological stimulation of the ovaries, which, in turn, causes an increase in the level of blood in the blood of another hormone, prolactin, against the background of a decrease in the content of other hormones.
This species also occurs frequently. Among the causes in most cases is the so-called adrenogenital syndrome. This syndrome manifests itself in the absence or inadequacy of enzymes that ensure the synthesis of hormones located in the adrenal cortex. These enzymes are called glucocorticoids. If they are absent, then all the substances that usually go to their processing, begin to be used by the body to produce androgens. For this reason, hyperandrogenism can be observed from the very childhood.
Often there is a combination of the two types of hyperandrogenia considered. In addition, adrenal hyperandrogenism is sometimes combined with some other diseases, since prolactin, which causes the production of androgens, simultaneously prevents the production of other, especially female hormones.
Pregnancy pregnancy with hyperandrogenism
As already mentioned, infertility is also called among the consequences that causes excessive amounts of androgens. Let us dwell on this aspect in more detail. The fact is that the disease most negatively affects the ovaries. In addition, at the first stages, inhibition of egg maturation is observed. In the future, as the disease progresses, the ovary becomes compacted. The shell also thickens, and the internal structure becomes a fertile soil for the emergence of a large number of small cysts. It turns out that even with the maturation of the egg, its exit becomes impossible. In other words, technically the possibility of fertilization is excluded.
But in some cases pregnancy is still possible. Unfortunately, the combination of hyperandrogenia and pregnancy causes either a spontaneous termination of pregnancy in the early stages, or the fading of pregnancy.
This is why it is very important to pay due attention to the first symptoms of hyperandrogenism and recognize it in time. Otherwise, the risk of aggravation of the situation is high: for example, interruption of pregnancy adversely affects the ratio of hormones in the body to a woman, causing imbalance. In the end, the onset of pregnancy is completely impossible.
After finding the first signs, any woman should immediately consult a doctor. The specialist, having studied the patient's complaints, appoints a survey. Also, the need to research a woman for lack of hyperandrogenism is indicated by infertility combined with some symptoms.
As part of the survey, various hormonal studies are conducted, which are aimed at detecting deviations in the level of the content of individual hormones. The method of ultrasound( ultrasound), some other specific methods, is also used.
After diagnosis, the most appropriate treatment for each specific case is determined. If the technique is chosen correctly and most importantly - in a timely manner, then soon a woman will be able to conceive and bear a child.
In the case when the diagnosis was carried out during pregnancy, the detected hyperandrogenia will necessitate the appointment of special drugs, whose action is aimed at reducing the level of androgens in the blood.
So, we have established what symptoms indicate the presence of hyperandrogenism. The consequences of this disease were established. We also examined the classification of the disease and the characteristics of the two most common varieties. Separately, the features of the course of pregnancy against the background of hyperandrogenism were determined. Finally, the main methods that are used in the course of diagnosis of the disease have been described. Now it is necessary to dwell on the issue of treatment of hyperandrogenism.
First of all, we note that the choice of the specific direction within which the treatment will take place depends on several factors at the same time:
- Of course, what kind of hyperandrogenism plays a role;
- Also takes into account the nature of the course of the disease.
In accordance with these circumstances, a specific treatment is determined. So, if hyperandrogenism is not accompanied by an increased content of androgens, then doctors usually prescribe tablets of various combined oral contraceptives. Such drugs contain antiandrogens. It is, for example, the preparations "Yarina", "Androkur", "Zhannin."
However, before their appointment, attention should be paid to a number of contraindications, including:
- the presence of thromboses of any kind( including those that develop in the history);
- severe liver disease;
- diabetes accompanied by angiopathy;
- is the so-called diabetic foot syndrome;
- presence of breast tumors, hormone-dependent tumors of the uterus and ovaries, tumors of the liver and adrenal glands;
- pregnancy and lactation;
- individual intolerance.
As you can see, the list is quite impressive. Therefore, before using the above drugs it is important to consult an endocrinologist.
Separate treatment is used in cases where women in the presence of symptoms of hyperandrogenism plan pregnancy. In such cases, specialists usually decide on hormonal therapy, which should ensure the stimulation of ovulation.
This method has one significant plus: in many cases, as a result of therapy, hyperandrogenism completely disappears, including all its external signs.
In some cases, ultrasound may reveal that the absence of ovulation is caused by sclerotic changes in the ovary capsule. Then the operative treatment is carried out, which is combined with hormonal therapy.
What other treatments are used? Of course, it can not do without surgical intervention. So, the need for this arises when there are tumors of the ovaries and adrenal glands. The fact is that it is almost impossible to predict exactly what will be the development of these tumors. Therefore, they resort to surgical removal.
In cases where adrenal hyperandrogenism is observed in women, corticosteroids( such as prednisolone, for example) are used. In the course of treatment with these drugs, it is important to determine what minimum dose is needed in order to normalize the activity of the adrenal glands.
Other treatments are available that are used when there are other symptoms accompanying hyperandrogenism:
a) treatment with prolactin-producing inhibitors( eg, bromiperptin is used).The method is used for mixed hyperandrogenism( adrenal and ovarian);
b) treatment by the administration of the drug "Klimen", which has an antiandrogenic effect. It is used in menopause;C) cosmetic procedures. Their conduct is possible only after a preliminary consultation of a specialist.
In conclusion, we present the main provisions concerning hyperandrogenism:
- This phenomenon occurs in 10-20% of women;
- The first symptoms of the disease are hirsutism, alopecia, barium, masculinization;
- There are several varieties of the disease, but the main ones are ovarian and adrenal hyperandrogenia;
- The specific treatment depends on which symptoms the disease is accompanied with.
- Symptoms of ovarian cyst