A case of severe hyperandrogenism, acanthosis nigricans and over diabetes: the use of non-invasive methods for diagnosis, pathogenesis and management.
Hyperandrogenism is characterized clinically by hirsutism, acne, androgens-dependent alopecia and elevated serum concentrations of androgens (testosterone and androstenedione). Polycystic ovary syndrome is the most frequent cause of hyperandrogenism. Nevertheless, the differential diagnosis includes androgen-secreting tumors of the ovary or adrenal gland. Although rare, it is important to consider this diagnosis in patients with serum testosterone concentrations greater than 7 nmol/l. A 35-year-old woman who presented with hirsutism, amenorrhea and acanthosis nigricans is described. The endocrine abnormalities included a serum testosterone concentration of 9 nmol/l and overt type II diabetes mellitus. Imaging studies, including magnetic resonance imaging and Doppler ultrasonography, did not disclose a secreting tumor. After cyproterone acetate was prescribed the serum testosterone concentration returned to normal. The recent application of modern, high-resolution diagnostic ultrasonography and magnetic resonance imaging enabled a morphologically based diagnosis in a case of severe hyperandrogenism, with no need for invasive procedures. The therapeutic response to antiandrogens is reassuring.
Grisaru
D
D
Department of Obstetrics and Gynecology A, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel.
Azem
F
F
Oren
M
M
Bar-Am
A
A
Inbar
M
M
Lessing
J B
JB
D000052:Acanthosis Nigricans / Q000150:complications*; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D017373:Cyproterone Acetate / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D010053:Ovary / Q000000981:diagnostic imaging; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography
D013739:Testosterone; D017373:Cyproterone Acetate