[Hyperandrogenism in premenopausal women].
Androgens are a family of steroids hormones secreted by the adrenal glands and the ovaries in women. The adrenal secretion of androgens becomes significant around the age of 7, at the onset of adrenal activity, and increases until ovarian puberty. The excess of adrenal androgens, of which the main products are dehydroepiandrosterone and its ester sulfate (DHEAS), is unrelated to a classic deficiency of steroid biosynthesis. Blocking with small doses of dexamethasone (0.5 then 0.25 mg at night), demonstrates that the DHEAS may be blocked and rules out a tumor of the adrenal cortex. This treatment, which presents tolerance problems, is effective on acne, but ineffective on hirsutism which requires the use of antiandrogens. In addition to this idiopathic adrenal hyperandrogenism, the late manifestations of a congenital deficiency in 21-hydroxylase in a clinical picture varying from a mere obesity to moderate hirsutism, but may evolve to a syndrome of polycystic ovaries, is easy to diagnose with a basic 17-hydroxyprogesterone assay. In this case, adrenal blocking by dexamethasone often gives a spectacular clinical result. Isolated ovarian hyperandrogenism, is found in the various clinical forms of the polycystic ovaries syndrome. Usually, this syndrome is suggested by the anovulation, cause of sterility, hirsutism and overweight. Ovarian ultrasonography is often difficult to explain, particularly because of the non-univocal macroscopic appearance of the ovaries. Therefore, a great deal of emphasis is placed on the hormonal exploration which shows an elevated concentration of serum testosterone (T) and mostly of delta-4 androstenedione (A), combined with an elevated luteinizing hormone (LH) which should be determined on several successive samples.(ABSTRACT TRUNCATED AT 250 WORDS)
Pugeat
M
M
Laboratoire de la Clinique Endocrinologique, Hôpital de l'Antiquaille, Lyon.
D000307:Adrenal Gland Diseases / Q000503:physiopathology; D000728:Androgens / Q000378:metabolism*; D005260:Female; D006801:Humans; D008593:Menopause; D010049:Ovarian Diseases / Q000503:physiopathology
D000728:Androgens
L'hyperandrogénie chez la femme avant la ménopause.