Click here to view next page of this article
Functional Ovarian Hyperandrogenism
Polycystic Ovarian Syndrome
Functional Adrenal Hyperandrogenism
Idiopathic
"Non classic" congenital adrenal hyperplasia
Cushing's syndrome
Hyperprolactinemia or Growth hormone excess
Increased peripheral androgen production or sensitivity
Idiopathic hirsutism
Androgen secreting tumors of the ovaries or adrenals
Clinical Approach
Is there evidence of virilization?
Recent onset and/or severe hirsutism with other features of virilization
Exclude tumor hyperandrogenism (ovarian or adrenal)
Usually associated with elevations of androgens more than 2 times normal
Is the patient Cushingoid?
Virilization plus Cushing's syndrome equals adrenal carcinoma until proved otherwise
LH:FSH ratio more than 2 are often but not always seen in PCO (functional ovarian hyperandrogenism)
Prolactin
Thyroid function
Non Classic Congenital Adrenal Hyperplasia;
Usually due to partial deficiency of 21 hydroxylase leading to increased production of 17-OH progesterone
More common in certain ethnic groups
Ashkenazi Jews; Yupic Eskimos
May be asymptomatic or present with functional hyperandrogenism or with infertility
Diagnostic test is ACTH stimulation test, measuring 17-OH progesterone at baseline and 60 min post ACTH
Basal 17-OH progesterone usually >200 ng/dL
Stimulated 17-OH progesterone usually >1000 ng/dL
Hirsutism -