Androgens in Health and Disease.pdf - E Library

128 Legro
Fig. 3. The paradox of androgen excess on pilosebaceous units of the face vs the scalp.
oughly investigated for androgen excess, most idiopathic cases disappear (8). Hirsutism
must also be differentiated from other causes of hair growth. Androgen-independent
hirsutism may be a familial tendency (familial hypertrichosis) or the result of medications,
such as cyclosporin, diazoxide, minoxidil, and so forth. These medications often
result in hypertrichosis, a generalized increase in body hair rather than the midline
development of marked terminal hair growth. Also in the differential of androgen excess
in an adult female is the use of exogenous androgens, anabolic steroids in a bodybuilder
for example, or an overdose of androgens in a postmenopausal women. Severe hirsutism
and even virilization that occurs during pregnancy has its own unique differential, including
benign ovarian sources such as hyperreactio luteinalis (i.e., gestational ovarian
theca–lutein cysts) or luteomas, and extremely rare fetoplacental sources such as
aromatase deficiency resulting in androgen excess as a result of the placental inability
to convert precursor androgens into estrogens.
Polycystic Ovary Syndrome
Polycystic ovary syndrome tends to develop shortly after menarche and last for
most of the reproductive life—although questions persist about its natural history
during the reproductive years. It has been proposed that premature pubarche may be
the earliest recognizable PCOS phenotype and affected girls display hyperinsulinemia,
and elevated DHEA-S levels, and after menarche they become oligomenorrheic (9).
At the other end of the reproductive spectrum, both menstrual irregularity (10) and
hyperandrogenemia (11) appear to normalize as women with PCOS approach their late
thirties to early forties. In addition to hirsutism, women with PCOS are plagued with
a variety of other ailments.
INFERTILITY: CHRONIC ANOVULATION
The most common reason that women with PCOS present to the gynecologist is
because of infertility, resulting from chronic anovulation (12). As a general rule, women
with PCOS represent one of the most difficult groups to induce ovulation both successfully
and safely. Many women with PCOS are unresponsive to clomiphene citrate and
human menopausal gonadotropins, and this is exacerbated by the underlying obesity. On
the other end of the spectrum are women with PCOS who overrespond to both of these