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Diseases of the Hair
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Rodney Sinclair, Wei-Liang Koh
Clinical presentation: Women with hirsutism present with increased terminal hairs in a male pattern, beyond what is considered “normal” for their race/ethnicity (Figure 23.16). Severity can be graded using the modified Ferriman-Gallwey hirsuitism score (Figure 23.17). Other symptoms and signs of hyperandrogenism include history of irregular menses, infertility, acne, FPHL, deepening of voice, increased muscle bulk, and cliteromegaly. Associated causes include polycystic ovarian syndrome (PCOS; with acanthosis nigricans, increased body mass index), nonclassic congenital adrenal hyperplasia (with precocious puberty), androgen-secreting ovarian/adrenal tumors (with acute rapid onset of virilization), Cushing’s syndrome (with hypertension, increased fat deposit midsection, face, between the shoulders, skin atrophy, easy bruising, violaceous striae), hyperprolactinemia (with galactorrhea), other endocrine disorders (e.g. acromegaly, thyroid disease), drugs (oral contraceptives, anabolic/androgenic steroids), and pregnancy.
Endocrinology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Mehul Dattani, Catherine Peters
Irregularities of the menstrual cycles can be controlled with oral contraceptive pills containing an antiandrogenic progesterone. Other antiandrogens (cyproterone acetate, spironolactone and flutamide) can also be used to alleviate the effects of hyperandrogenism. Insulin sensitisers, including metformin, and dermatological treatments may also be considered.
Polycystic ovary syndrome and hyperandrogenism in adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Andrea E. Bonny, Asma Javed Chattha
PCOS is a diagnosis of exclusion, and the clinical evaluation commences with a search for disorders mimicking the condition. These include, but are not limited to, other causes of hyperandrogenism and oligo/anovulation such as late-onset congenital adrenal hyperplasia, adrenal or ovarian tumors, hyperprolactinemia, thyroid dysfunction, and premature ovarian failure.101
The effect of adding L-Carnitine to the GnRH-antagonist protocol on assisted reproductive technology outcome in women with polycystic ovarian syndrome: a randomized clinical trial
Published in Gynecological Endocrinology, 2023
Arezoo Sheida, Robab Davar, Nasim Tabibnejad, Maryam Eftekhar
A total of 83 individuals with PCOS-related infertility aged between 18 and 40 years old, who were candidates for ART treatment, were included in the study. The study was implemented at Yazd Reproductive Sciences Institute during a 5-month period from January to May 2020. The diagnosis of PCOS was based on the Rotterdam criteria [11] including polycystic ovaries on ultrasonography (≥12 small follicles measuring 2–9 mm in at least one ovary and/or ovarian volume >10 cm3)., oligomenorrhea and/or anovulation (delayed menstruation more than 35 days, or less than 8 natural hemorrhagic periods per year), and biochemical and/or clinical signs of hyperandrogenism. Signs of hyperandrogenism, such as acne and hirsutism, were evaluated on physical examination and total testosterone level higher than the adult female normal values was considered a feature of biochemical hyperandrogenism. Women with a history of severe endometriosis, other endocrine disorders, and azoospermia in their husbands were excluded from the study. Subjects were randomized to either L-Carnitine supplemented (n = 42) or control (n = 41) groups using computer-generated random numbers in sealed, unnamed envelopes each holding a single number. The participants, nurses, and physicians were not blinded to the allocated group.
Clinical pregnancy rates among anovulatory and oligoovulatory women after letrozole versus hormone replacement therapy in frozen-thawed embryo transfer cycles
Published in Human Fertility, 2023
Maya Sharon-Weiner, Sivan Farladansky-Gershnabel, Hanoch Schreiber, Tal Shavit, Eliahu Levitas, Arie Berkovitz
According to our clinical approach, inclusion criteria were women with anovulatory (absence of at least three consecutive menstrual periods) or oligoovulatory (menstrual periods occurring at intervals greater than 35 days) cycles who underwent FET. This study cohort was composed of women who needed progesterone-based treatment for withdrawal bleeding, as determined by laboratory evaluation for ovulation on days 21 and 30 of the cycle (a serum progesterone level >3 ng/mL is indicative of ovulation). Regarding the baseline aetiology for oligoovulation or anovulation, we included all women with oligoovulation or anovulation, not only PCOS (the most frequent pathology causing anovulation during the reproductive years). As defined by the Rotterdam consensus, PCOS is diagnosed when at least two of these three criteria are met: (i) oligo-anovulation or anovulation; (ii) clinical or biochemical signs of hyperandrogenism; and (iii) polycystic ovarian morphology on ultrasound (as defined by at least one ovary with ≥12 follicles or volume ≥10 cm3).
From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach
Published in Gynecological Endocrinology, 2022
Patrycja Rojewska, Blazej Meczekalski, Grzegorz Bala, Stefano Luisi, Agnieszka Podfigurna
Androgen-secreting ovarian tumors are rare, constituting around 1% of all ovarian tumors. Typically, these tumors manifest with rapidly increasing hyperandrogenization, specifically hirsutism, acne, frontal balding, and in more severe cases virilization. Careful and insightful diagnostics should be undertaken in every case of hyperandrogenism. The diagnostic process should include a thorough medical interview, physical examination (with the assessment of hirsutism using the modified Ferriman-Gallwey scale), laboratory tasting (serum testosterone, DHEA-S, androstenedione, 17-OHP levels), comprehensive imaging (Preliminary TVU with color Doppler preferred), and MRI. Most often, ASNs originate from the cells of the sex cord or stroma of the ovary. Sertoli-Leydig Cell Tumors, which in 75% of cases affect women under the age of 30 years, is the most frequently occurring ASN, while Leydig Cell Tumors are more commonly diagnosed in postmenopausal women. Both SLCT and LCT are typically unilateral and benign. If there are no preexisting contraindications, ovarian tumors should be treated surgically with bilateral oophorectomy. In the presence of unmitigable contraindications, treatment with GnRH agonists can be considered. Other tumors, such as SCSTs and metastases (mostly of a gastric origin) are also seen but the incidence of these is comparatively low.