Ovarian overproduction of androgens

Definition

Ovarian overproduction of androgens is a condition in which the female ovaries make too much testosterone. This leads to the development of male characteristics in a woman. Other hormones, called androgens, from other parts of the body can also cause the development of male characteristics in women.

Causes, incidence, and risk factors

In healthy women, the ovaries and adrenal glands produce about 40 - 50% of the body's testosterone. Both tumors of the ovaries and polycystic ovary syndrome (PCOS) can cause excess androgens.

Cushing's disease, an abnormality in the pituitary gland, causes excess amounts of corticosteroids, which cause masculine body changes in women. Also, tumors in the adrenal glands can cause overproduction of androgens and lead to male body characteristics in women.

Symptoms

Hyperandrogenism:

• Acne
• Amenorrhea (absence of menstrual periods)
• Changes in female body contours
• Decrease in breast size
• Increase in body hair in a male pattern (hirsutism)
• Oily skin

Virilization:

• Clitoromegaly (enlargement of the clitoris)
• Deepening of the voice
• Increase in muscle mass
• Temporal balding (thinning hair and hair loss)

Signs and tests

• 17-hydroxyprogesterone
• ACTH test
• CT scan
• Glucose and insulin level tests
• Pelvic ultrasound
• Prolactin (if periods are infrequent or absent)
• Testosterone
• TSH (if there is balding)

Treatment

Treatment depends on the problem that is causing the increased androgen production. Medications can be given to decrease hair production in patients who have excess body hair (hirsutism) or to regulate menstrual cycles. In some cases, surgery may be necessary to remove an ovarian or adrenal tumor.

Expectations (prognosis)

The success of the treatment depends on what caused the excess androgen production. If the condition is caused by an ovarian tumor, surgical removal of the tumor may correct the problem. Most ovarian tumors are not cancerous (benign), and will not come back after they've been removed.

In polycystic ovary syndrome, the following can reduce symptoms caused by increased androgen levels:

• Careful monitoring
• Dietary changes
• Medications
• Regular vigorous exercise

Complications

Infertility is a possible complication.

Women with polycystic ovary syndrome may be at increased risk for:

• Diabetes
• High blood pressure
• Obesity
• Uterine cancer

Prevention

There is no known prevention.

References

Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Katz V, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 40.