title: Mild cutaneous manifestation in two young women with extraordinary hyperandrogenemia.
abstract: Hyperandrogenism with hyperandrogenemia should be considered in those with severe acne of sudden onset or conspicuous male-pattern baldness with hairline recession, although the majority of female patients with acne or androgenetic alopecia possess no endocrine disorder. Herein we describe on the contrary 2 young women with primary amenorrhea displaying prominent hyperandrogenemia but subtle cutaneous manifestation. The first one presenting vertical alopecia had an elevated level of serum dehydroepiandrosterone sulfate (>800 microg/dl) and was suspected to be a case of late-onset, non-classical adrenal hyperplasia. The second case with mild acne had a soaring serum level of total testosterone >9,000 ng/dl derived from an androgen-secreting adrenal adenoma overexpressing steroidogenic acute regulatory protein, P450 side-chain cleavage enzyme and aromatase. A careful patient history and a complete physical examination are mandatory in each individual female case with acne or alopecia. The possibility of adrenal tumor should be explored in patients with escalated circulating testosterone.
authors.affiliation: Department of Dermatology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan. wchen@cgmh.org.tw
authors.forename: WenChieh
authors.initials: W
authors.lastname: Chen
authors.forename: Guan-Yu
authors.initials: GY
authors.lastname: Chen
authors.forename: Shaw-Jenq
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Wang
authors.forename: Hamm-Ming
authors.initials: HM
authors.lastname: Sheu
authors.forename: Yen-Sheng
authors.initials: YS
authors.lastname: Shen
authors.forename: Fen-Fen
authors.initials: FF
authors.lastname: Chen
mesh_terms: D000152:Acne Vulgaris / Q000150:complications* / Q000473:pathology; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D000505:Alopecia / Q000150:complications* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed