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Ovarian overproduction of androgens
Definition
Ovarian overproduction of androgens is a condition in which the female ovaries make too much testosterone. This leads to the development of male characteristics in a woman. Other hormones, called androgens, from other parts of the body can also cause the development of male characteristics in women.
Causes
In healthy women, the ovaries and adrenal glands produce about 40 - 50% of the body's testosterone. Both tumors of the ovaries and polycystic ovary syndrome (PCOS) can cause excess androgen production.
Cushing's disease, an abnormality in the pituitary gland, causes excess amounts of corticosteroids, which cause masculine body changes in women. Also, tumors in the adrenal glands can cause overproduction of androgens and lead to male body characteristics in women.
Symptoms
Hyperandrogenism:
- Acne
- Amenorrhea (absence of menstrual periods)
- Changes in female body contours
- Decrease in breast size
- Increase in body hair in a male pattern (hirsutism) such as on the face, chin, and abdomen
- Oily skin
Virilization:
- Clitoromegaly (enlargement of the clitoris)
- Deepening of the voice
- Increase in muscle mass
- Temporal balding (thinning hair and hair loss)
Exams and Tests
Your health care provider will perform a physical exam. Any blood and imaging tests ordered will depend on your specific symptoms, but may include:- 17-hydroxyprogesterone test
- ACTH test
- CT scan
- DHEA blood test
- Glucose test
- Insulin test
- Pelvic ultrasound
- Prolactin (if periods are infrequent or absent) test
- Testosterone test
- Total cholesterol test
- TSH test (if there is hair loss)
Treatment
Treatment depends on the problem that is causing the increased androgen production. Medications can be given to decrease hair production in patients who have excess body hair (hirsutism) or to regulate menstrual cycles. In some cases, surgery may be necessary to remove an ovarian or adrenal tumor.
Outlook (Prognosis)
The success of the treatment depends on what caused the excess androgen production. If the condition is caused by an ovarian tumor, surgical removal of the tumor may correct the problem. Most ovarian tumors are not cancerous (benign), and will not come back after they've been removed.
In polycystic ovary syndrome, the following can reduce symptoms caused by increased androgen levels:
- Careful monitoring
- Dietary changes
- Medications
- Regular vigorous exercise
Possible Complications
Infertility and complications during pregnancy may occur.
Women with polycystic ovary syndrome may be at increased risk for:
- Diabetes
- High blood pressure
- High cholesterol
- Obesity
- Uterine cancer
Prevention
There is no known prevention. Maintaining a normal weight through healthy diet and regular exercise can reduce your chances of any long-term complications.
References
Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier;2012:chap 40.
Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 17.
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
