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Hirsutism
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Benjamin L. Palmer, Lauren A. Kanner
Ovarian causesAnovulation/polycystic ovary syndrome (PCOS): Most common pathologic etiology (see Chapter 39, “Polycystic Ovary Syndrome”)Stromal hyperthecosisOvarian tumorsEnzyme deficiency (17-ketosteroid reductase)
Polycystic Ovary Syndrome
Published in Steven R. Bayer, Michael M. Alper, Alan S. Penzias, The Boston IVF Handbook of Infertility, 2017
Rita M. Sneeringer, Kristen Page Wright
The dysregulation of LH in PCOS patients has been reported in multiple studies and may account for many of the clinical symptoms of PCOS. Increased pulsatile GnRH secretion leads to increased LH pulse frequency. The primary cause of increased GnRH is unclear; it could be an intrinsic abnormality of the pulse generator or secondary to other factors such as chronically low levels of progesterone (from anovulation) or hyperinsulinemia [23–25]. Women with PCOS have reduced hypothalamic sensitivity to ovarian sex steroids [26] and enhanced pituitary sensitivity to GnRH, which likely contributes to the increased LH secretion and pulse amplitude. The increased LH secretion relative to FSH stimulates ovarian androgen (testosterone and androstenedione) production, leading to clinical hyperandrogenism. Anovulation results from insufficient selection of a dominant follicle in the setting of hyperthecosis.
Amenorrhea and hirsutism
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
The common causes of hirsutism are summarized in Table 18.5. PCOS accounts for most cases,11,12,35,36 including not only women with the classic combination of oligomenorrhea and hirsutism but also women who have regular cycles and hirsutism.11 Nearly 90% of women with hirsutism and regular cycles, who may previously have been regarded as having idiopathic hirsutism,11,35 have polycystic ovaries. Hyperthecosis is a somewhat nebulous entity, mainly based on histological appearance, which, especially in premenopausal women, probably represents an extreme of the polycystic ovary. In hyperthecosis, there are “islands” of theca cells within the stroma, as well as in follicles, and these islands are presumed to contribute to excess androgen production. In postmenopausal women, these foci of stromal androgen production may be further activated by high circulating levels of LH. Androgen-secreting tumors of the ovary are rare, but it is clearly important to make an early diagnosis based on history and, usually, greatly elevated serum levels of testosterone.
Hyperthecosis: an underestimated nontumorous cause of hyperandrogenism
Published in Gynecological Endocrinology, 2021
Blazej Meczekalski, Anna Szeliga, Marzena Maciejewska-Jeske, Agnieszka Podfigurna, Paulina Cornetti, Gregory Bala, Eli Y. Adashi
Hyperthecosis remains a rare and neglected cause of severe hyperandrogenism in women. It should always be considered when working up a patient with hyperandrogenism. It is important to remember it can mimic androgen secreting tumors, but should also be ruled out when assessing any patient with PCOS.
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
Ovarian hyperthecosis is a benign form of luteinized thecal cell hypertrophy in the ovarian stroma that produces excess testosterone. It is not entirely clear whether ovarian hyperthecosis is in and of itself a separate disorder or falls under the spectrum of PCOS.