Differential diagnosis of hyperandrogenism syndrome and the possibility of its correction
https://doi.org/10.30629/0023-2149-2022-100-4-5-165-172
Abstract
This lecture discusses the issues of diagnosis and correction of pathological conditions accompanied by hyperandrogenism in women. The most common causes of a symptom complex caused by an increase in the level of androgens are polycystic ovarian syndrome, congenital dysfunction of the adrenal cortex, endogenous hypercortisolism, androgen-producing tumors. The data presented are based on clinical guidelines approved by the Russian Ministry of Health, consistent with the principles of evidence-based medicine.
About the Authors
I. S. Zakharov
Military Medical Academy named after S.M. Kirov of the Ministry of Defense of Russia
Russian Federation
Russian Federation
194044, Saint Petersburg
A. A. Schmidt
Military Medical Academy named after S.M. Kirov of the Ministry of Defense of Russia
Russian Federation
Russian Federation
194044, Saint Petersburg
S. V. Beskrovny
Military Medical Academy named after S.M. Kirov of the Ministry of Defense of Russia
Russian Federation
Russian Federation
194044, Saint Petersburg
V. G. Abashin
Central Military Clinical Hospital named after P.V. Mandryka of the Ministry of Defense of Russia
Russian Federation
Russian Federation
107014, Moscow
References
1. Berman J., Almeida F., Jolin J., Raz S., Chaudhuri G., Gonzalez-Cadavid N.F. Correlation of androgen receptors, aromatase, and 5-alpha reductase in the human vagina with menopausal status. Fertil. Steril. 2003;79(4):925–931. DOI: 10.1016/s0015-0282(02)04923-3
2. Traish A.M., Kim S.W., Stancovic M., Goldstein I., Kim N.N. Testosterone increase blood flow and expression of androgen and estrogen receptors in the rat vagina. J. Sex. Med. 2007;4(3):609–619. DOI: 10.1111/j.1743-6109.2007.00491.x
3. Notelovitz M. Androgen effects on bone and muscle. Fertil. Steril. 2002;77(4):34–41. DOI: 10.1016/s0015-0282(02)02968-0
4. Pluchino N., Carmignani A., Cubeddu A., Santoro A., Cela V., Errasti T. Androgen therapy in women: for whom and when? Arch. Gynecol. Obstet. 2013;288(4):731–737. DOI: 10.1007/s00404-013-2969-7
5. Tan R.S., Teoh S.H. Testosterone use in women: how safe is it? Curr. Drug Saf. 2013;8(2):120–127. DOI:10.2174/1574886311308020005
6. Калинченко С.Ю., Тюзиков И.А., Тишова Ю.А., Ворслов Л.О. Роль тестостерона в женском организме. Общая и возрастная эндокринология тестостерона у женщин. Доктор.Ру. Гинекология эндокринология. 2015;115(14):59–64. [Kalinchenko S.Yu., Tyuzikov I.A., Tishova Yu.A., Vorslov L.O. Testosterone Functions in Women. General and Age-Specific Endocrine Functions of Tes tosterone in Women. Doctor.Ru Gynecology Endocrinology. 2015;115(14):59–64. (In Russian)]
7. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod. 2004;19(1):41–47. DOI: 10.1093/humrep/deh098
8. Teede H.J., Misso M.L., Costello M.F. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil. Steril. 2018;110(3):364–379. DOI: 10.1016/j.fertnstert.2018.05.004
9. Зайдиева З.С., Уруймагова А.Т. Синдром поликистозных яичников: современные представления патогене за, диагностикии лечения. Медицинский совет. 2021;(13):102–111. [Zaydiyeva Z.S., Uruymagova А.Т. Polycystic ovarian syndrome: current understanding of pathogenesis, diagnosis and treatment. Meditsinskiy sovet = Medical Council. 2021;(13):102–111. (In Russian)]. DOI: 10.21518/2079- 701X-2021-13-102-111
10. Захаров И.С., Букреева Е.Л. Оксидативный стресс при синдроме поликистозных яичников: прогностическое значение, возможности коррекции. Гинекология. 2018;20(1):35–38. [Zakharov I.S., Bukreeva E.L. Oxidative stress in the syndrome of polycystic ovaries: prognostic value, correction possibilities. Gynecology. 2018;20(1):35–38. (In Russian)]. DOI: 10.26442/2079-5696_20.1.35-38
11. Neven A.C.H., Laven J., Teede H.J., Boyle J.A. A Summary on Poly cystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines. Semin. Reprod. Med. 2018;36(1):5–12. DOI:10.1055/s-0038-1668085
12. Yildiz B.O., Bolour S., Woods K., Moore A., Azziz R. Visually sco ring hirsutism. Hum. Reprod Update. 2010;16(1):51–64. DOI: 10.1093/humupd/dmp024
13. Lause M., Kamboj A., Fernandez Faith E. Dermatologic manifestations of endocrine disorders. Transl. Pediatr. 2017;6(4):300–312. DOI: 10.21037/tp.2017.09.08
14. Randeva H.S., Tan B.K., Weickert M.O., Lois K., Nestler J.E., Sat tar N., Lehnert H. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr. Rev. 2012;33(5):812–841. DOI: 10.1210/er.2012-1003
15. Carvalho M.J., Subtil S., Rodrigues Â., Oliveira J., FigueiredoDias M. Controversial association between polycystic ovary syndrome and breast cancer. Eur. J. Obstet. Gynecol. Reprod. Biol. 2019;243:125–132. DOI: 10.1016/j.ejogrb.2019.10.011
16. Meczekalski B., Pérez-Roncero G.R., López-Baena M.T., Chedraui P., Pérez-López F.R. The polycystic ovary syndrome and gyne cological cancer risk. Gynecol Endocrinol. 2020;36(4):289–293. DOI: 10.1080/09513590.2020.1730794
17. Wen Y., Wu X., Peng H., Li C. , Jiang Y., Su Z., Liang H., Liu J.,He J., Liang W. Breast cancer risk in patients with polycystic ovary syndrome: a Mendelian randomization analysis. Breast Cancer Res. Treat. 2021;185(3):799–806. DOI: 10.1007/s10549-020-05973-z
18. Rosenfield R.L. The Polycystic Ovary Morphology-Polycystic Ovary Syndrome Spectrum. J. Pediatr. Adolesc. Gynecol. 2015;28(6):412–419. DOI: 10.1016/j.jpag.2014.07.016
19. Jeanes Y.M., Reeves S. Metabolic consequences of obesity and insulin resistance in polycystic ovary syndrome: diagnostic and methodological challenges. Nutr. Res. Rev. 2017;30(1):97–105. DOI: 10.1017/S0954422416000287
20. Teede H., Misso M., Tassone E.C., Dewailly D., Ng E.H., Azziz R., Nor man R.J., Andersen M., Franks S., Hoeger K., Hutchison S., Oberfield S., Shah D., Hohmann F., Ottey S., Dabadghao P., Laven J.S.E. Anti-Müllerian Hormone in PCOS: A Review Informing International Guidelines. Trends Endocrinol. Metab. 2019;30(7):467–478. DOI: 10.1016/j.tem.2019.04.006
21. Sova H., Unkila-Kallio L., Tiitinen A., Hippeläinen M., Perheen tupa A., Tinkanen H., Puukka K., Bloigu R., Piltonen T., Tapanai nen J.S., Morin-Papunen L. Hormone profiling, including anti Müllerian hormone (AMH), for the diagnosis of polycystic ovary syndrome (PCOS) and characterization of PCOS phenotypes. Gynecol. Endocrinol. 2019;35(7):595–600. DOI:10.1080/09513590.2018.1559807
22. Мельниченко Г.А., Трошина Е.А., Молашенко Н.В., Сазонова А.И., Ужегова Ж.А. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечебно-профилактическим мероприятиям при врожденной дисфункции коры надпочечников у пациентов во взрослом возрасте. Consilium Medicum. 2016;18(4):8–19. [Melnichenko G.A., Troshina E.A., Molashenko N.V., Sazonova A.I., Uzhegova Zh.A. Russian Association of Endocrinologists clinical practice guidelines for diagnosis, treatment and preventive measures in congenital adrenal hyperplasia due to 21-hydroxylase deficiency patients in adulthood. Consilium Medicum. 2016;18(4):8–19. (In Russian)]
23. Lesma A., Bocciardi A., Corti S., Chiumello G., Rigatti P., Montorsi F. Sexual function in adult life following Passerini-Glazel feminizing genitoplasty in patients with congenital adrenal hyperplasia. J. Urol. 2014;191(1):206–211. DOI: 10.1016/j.juro.2013.07.097
24. Марова Е.И., Арапова С.Д., Белая Ж.Е. Болезнь Иценко–Кушинга: клиника, диагностика, лечение. М., ГЭОТАР-Медиа, 2012:64. [Marova E.I., Arapova S.D., Belaya Zh.E. Bolezn’ ItsenkoKushinga: klinika, diagnostika, lechenie. M., 2012:64. (In Russian)]
25. Белая Ж.Е., Рожинская Л.Я., Мельниченко Г.А., Дедов И.И. Современный взгляд на скрининг и диагностику эндогенного гиперкортицизма. Проблемы эндокринологии. 2012;58(4):35–41 [Belaya Zh.E., Rozhinskaya L.Ya., Melnichenko G.A., Dedov I.I. Current views of the screening and diagnostics of endogenous hypercorticism. Problems of endocrinology. 2012;58(4):35–41. (In Russian)]
26. Bertagna X., Guignat L. Approach to the Cushing’s disease patient with persistent/recurrent hypercortisolism after pituitary surgery Clinical Endocrinology Metabolism. 2013;98(4):1307–1318. DOI:10.1210/jc.2012-3200
27. Григорьев А.Ю., Азизян В.Н., Иващенко О.В., Надеждина Е.Ю. Повторная транссфеноидальная аденомэктомия при рецидиве и персистирующем течении болезни Иценко–Кушинга. Нейрохирургия. 2014;(2):49–53. [Grigoriev A.J., Azizian V.N., Iva shenko O.V., Nadezhdina E.J. The repeated transsphenoidal ade nomectomy because of relapse and persistent course of Itsenko–Kushing disease. Russian journal of neurosurgery. 2014;(2):49–53. (In Russian)]. DOI: 10.17650/1683-3295-2014-0-2-49-53
28. Gadelha M.R., Neto L.V. Efficacy of medical treatment in Cushing’s disease: a systematic review. Clinical Endocrinology. 2014;80(1):1–12. DOI: 10.1111/cen.12345
29. Ding D., Starke R., Sheehan J. Treatment paradigms for pituitary ade nomas: defining the roles of radiosurgery and radiation therapy. Neuro oncol. 2014;117(3):445–457. DOI: 10.1007/s11060-013-1262-8
30. Morris L.F., Harris R.S., Milton D.R., Waguespack S.G., Habra M.A., Jimenez C., Vassilopoulou-Sellin R., Lee J.E., Perrier N.D., Grubbs E.G. Impact and timing of bilateral adrenalectomy for re fractory adrenocorticotropic hormone — dependent Cushing’s syn drome. Surgery. 2013;154(6):1174–1183. DOI: 10.1016/j.surg.2013.06.017
31. Мельниченко Г.А., Стилиди И.С., Алексеев Б.Я., Горбунова В.А., Бельцевич Д.Г., Райхман А.О., Кузнецов Н.С., Жуков Н.В., Бохян В.Ю. Федеральные клинические рекомендации по диагностике и лечению адренокортикального рака. Проблемы эндокринологии. 2014;60(2):51–67. [Melnichenko G.A., Stilidi I.S., Alekseev B.Y., Gorbunova V.A., Beltsevich D.G., Raikhman A.O., Kuznetsov N.S., Zhukov N.V., Bokhyan V.Yu. Federal clinical practice guidelines on the diagnostics and treatment of adrenocortical cancer. Problems of Endocrinology. 2014;60(2):51–67. (In Russian)]. DOI: 10.14341/probl201460251-67
32. Adrenal Cortical Carcinoma. In: Brierley J.D., Gospodarowicz M.K., Wittekind C. (eds). TNM Classification of Malignant Tumours (8th edition). Oxford, UK: Wiley-Blackwell, 2017.
33. Fassnacht M., Dekkers O., Else T., Baudin E., Berruti A., de Krijger R., Haak H., Mihai R., Assie G., Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the Management of Adrenocortical Carcinoma in Adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur. J. Endocrinol. 2018;179(4):G1–G46. DOI: 10.1530/EJE-18-0608
34. Pommier R.F., Brennan M.F. An eleven-year experience with adrenocortical carcinoma. Surgery. 1992;112(6):963–970.
Review
For citations:
Zakharov I.S., Schmidt A.A., Beskrovny S.V., Abashin V.G. Differential diagnosis of hyperandrogenism syndrome and the possibility of its correction. Clinical Medicine (Russian Journal). 2022;100(4-5):165-172. (In Russ.) https://doi.org/10.30629/0023-2149-2022-100-4-5-165-172
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