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.
Department of Obstetrics and Gynecology A, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel.
D
D
Grisaru
F
F
Azem
M
M
Oren
A
A
Bar-Am
M
M
Inbar
J B
JB
Lessing
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