University of Alcalá and Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria and Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas, E-28034 Madrid, Spain.
J Clin Endocrinol Metab. 2012 Aug;97(8):2584-8. doi: 10.1210/jc.2012-1683. Epub 2012 Jun 5.
Mild clinical signs of hyperandrogenism such as hirsutism may appear during the menopausal transition as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess, including androgen-secreting tumors.
A 68-yr-old postmenopausal woman was referred because of a history of progressive development of hirsutism and frontal balding for the previous 8 yr, together with moderate hyperandrogenemia. Initial imaging procedures depicted a 2-cm solid nodule in the right adrenal gland and normal appearance of both ovaries. To confirm the source of androgen excess, we conducted simultaneous selective venous sampling of adrenals and ovaries. Sampling was consistent with an ovarian source. After bilateral laparoscopic salpingo-oophorectomy, the patient was diagnosed with bilateral ovarian hyperthecosis. Three weeks after surgery, her androgen levels had decreased to the normal female range.
Diagnosis of hyperandrogenism in postmenopausal women is challenging. Postmenopausal virilization may be associated with adrenal or ovarian androgen-secreting tumors or with benign conditions. A detailed clinical history is critical to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. Imaging techniques do not always reveal the cause of hyperandrogenism and may even be misleading. Although technically difficult, combined adrenal and ovarian venous sampling may be required to confirm the source of androgen excess before the best surgical approach is determined.
在绝经过渡期间，可能会出现轻度的雄激素过多的临床症状，如多毛症，这可能是正常衰老过程的一部分，但明显的男性化表现提示存在特定的雄激素过多来源，包括雄激素分泌肿瘤。
一位 68 岁的绝经后妇女因进行性多毛症和额部脱发病史（此前 8 年逐渐加重）、中度高雄激素血症而就诊。最初的影像学检查显示右侧肾上腺有一个 2 厘米的实性结节，双侧卵巢外观正常。为了明确雄激素过多的来源，我们对肾上腺和卵巢进行了同时选择性静脉采样。采样结果提示来源为卵巢。在接受双侧腹腔镜输卵管卵巢切除术（salpingo-oophorectomy）后，该患者被诊断为双侧卵巢性索间质增生。术后 3 周，其雄激素水平降至正常女性范围。
绝经后女性的雄激素过多症诊断具有挑战性。绝经后女性的男性化可能与肾上腺或卵巢的雄激素分泌肿瘤或良性疾病有关。详细的临床病史对于区分良性病因导致的多毛症进行性发展与恶性肿瘤导致的快速进展至关重要。影像学技术并不总是能揭示雄激素过多的原因，甚至可能具有误导性。虽然技术上具有挑战性，但在确定最佳手术方法之前，可能需要进行联合肾上腺和卵巢静脉采样以确认雄激素过多的来源。
