Rosenfield R L
University of Chicago, Pritzker School of Medicine, Illinois.
Pediatr Clin North Am. 1990 Dec;37(6):1333-58. doi: 10.1016/s0031-3955(16)37014-6.
Androgens arise from either adrenal or ovarian secretion or by peripheral conversion of secreted precursors. The adrenals and ovaries normally contribute about equally to testosterone and AD production. DHAS is the major adrenal 17-KS. Testosterone is the major circulating form of androgen. More than 96% of plasma testosterone is bound to SHBG; the free testosterone seems to be the bioavailable fraction. Hyperandrogenism must be considered in any girl with premature or excessive development of public hair or acne, menstrual irregularity (whether it be oligo-amenorrhea or dysfunctional uterine bleeding), or obesity. The most common cause of premature public hair development (pubarche) is premature adrenarche. The most common cause of hyperandrogenism presenting in a teenage girl is polycystic ovary syndrome. However, the differential diagnosis includes "exaggerated adrenarche," late-onset congenital adrenal hyperplasia, virilizing tumors, Cushing's syndrome, hyperprolactinemia, acromegaly, and abnormalities of androgen action or of metabolism. The plasma free testosterone is a more sensitive indicator of hyperandrogenism than is the total testosterone concentration. The pattern of response of plasma free testosterone, DHAS, and cortisol to dex-suppression testing is diagnostic of the source of androgen excess. Most hyperandrogenic adolescents will be found to have PCOS. The treatment is chosen according to particular symptoms, such as menstrual irregularity, hirsutism, or obesity.
雄激素可源于肾上腺或卵巢分泌，也可由分泌的前体物质经外周转化而来。肾上腺和卵巢对睾酮及雄烯二酮生成的贡献通常大致相同。硫酸脱氢表雄酮是肾上腺主要的17-酮类固醇。睾酮是循环中主要的雄激素形式。超过96%的血浆睾酮与性激素结合球蛋白结合；游离睾酮似乎是具有生物活性的部分。任何出现阴毛过早或过度生长、痤疮、月经不规律（无论是月经过少或闭经还是功能失调性子宫出血）或肥胖的女孩都必须考虑高雄激素血症。阴毛过早发育（阴毛初现）最常见的原因是肾上腺功能初现过早。青少年女性高雄激素血症最常见的原因是多囊卵巢综合征。然而，鉴别诊断包括“肾上腺功能初现亢进”、迟发性先天性肾上腺皮质增生症、雄激素分泌性肿瘤、库欣综合征、高催乳素血症、肢端肥大症以及雄激素作用或代谢异常。血浆游离睾酮比总睾酮浓度更能敏感地反映高雄激素血症。血浆游离睾酮、硫酸脱氢表雄酮和皮质醇对地塞米松抑制试验的反应模式可诊断雄激素过多的来源。大多数高雄激素血症的青少年被发现患有多囊卵巢综合征。治疗方案根据具体症状选择，如月经不规律、多毛或肥胖。
