Hyperandrogenism

Hyperandrogenemia is a very common disease among women, but people probably don't know much about it. They don't know what's going on. Generally, people with this phenomenon may suffer from polycystic ovary syndrome, followed by hyperadrenal cortex function. Everyone should know that if androgen is excessive, women will have some male characteristics, and the same is true for hyperandrogenemia.

The female body can only function normally if the hormone secretion is balanced. If there is too much male hormone, some male characteristics will appear. Patients with hyperandrogenism can stimulate the female ovaries to secrete a large amount of male hormone, which will cause some male physical signs.

During the follicular phase of a normal menstrual cycle, the average serum testosterone concentration is 0.43 ng/ml, with a maximum limit of 0.68 ng/ml. If it exceeds 0.7 ng/m1 (equal to 2.44 nmol/L), it is called hypertestosteronemia or hyperandrogenism. The ovaries, adrenal cortex, etc. can synthesize cholesterol from acetic acid, or absorb cholesterol from the blood as a matrix, synthesize steroid hormones, and secrete them into the blood circulation. Hypertestosteronism is caused by excessive levels of these hormones, especially testosterone, in the blood.

Pathogenesis

The main androgens in the blood circulation include dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione (Δ4A), testosterone (T) and dihydrotestosterone (DHT).

Causes of high blood androgen: ① Due to excessive secretion of ovaries or adrenal cortex. ②It may also be caused by abnormal peripheral conversion. ③Dysfunction of the enzyme system during the biosynthesis of steroid hormones, such as aromatase deficiency, means that androstenedione cannot be converted into estrone, and testosterone cannot be converted into estradiol, resulting in excessive accumulation of androstenedione, especially testosterone. ④60% of testosterone is bound to β-globulin in the blood, called testosterone-estradiol binding globulin (TEBG), about 38% (mainly androstenedione) is bound to albumin, and free testosterone accounts for only 2%, but it is active. If TEBG bound estradiol increases and bound testosterone decreases, the free testosterone in the blood will increase. ⑤ Hyperinsulinemia caused by insulin resistance can stimulate the ovaries to secrete large amounts of androgens.

The cause of infertility caused by hypertestosterone: the ovaries and adrenal glands secrete too much hormone, which circulates through the blood and is converted into estrone by aromatase in the peripheral fat tissue. Excessive estrone continuously acts on the hypothalamus and pituitary gland, causing positive feedback on the secretion of LH and negative feedback on the secretion of FSH, resulting in high LH levels and low FSH levels without periodic fluctuations. The LH/FSH ratio increases by ≥2 to 3. Low FSH causes the follicles to develop to a certain extent, but not to mature; LH secretion increases continuously, but there is no cyclical fluctuation, that is, there is no LH peak. As a result, ovulation does not occur, leading to infertility.

Clinical manifestations

The more common ones are menstrual changes such as oligomenorrhea, amenorrhea or dysfunctional uterine bleeding, anovulation and infertility. Some have masculine changes, such as excessive hair growth, enlarged Adam's apple, and deeper voice. Some are obese, have acne, poor breast development, poor uterine development, enlarged ovaries, and in a few cases, clitoromegaly.

There are many causes of hyperandrogenemia. Generally, it is caused by excessive secretion of androgen by the ovaries and adrenal cortex. Hyperandrogenemia can cause many harms to women. It can also lead to female infertility, less menstruation, or even amenorrhea and anovulation. Some patients will have some masculinization changes, so they must be treated in time.