Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
MRC Epidemiology Unit, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK.
Nat Rev Endocrinol. 2014 Aug;10(8):499-508. doi: 10.1038/nrendo.2014.58. Epub 2014 Apr 29.
Hyperinsulinaemic androgen excess is the most common cause of hirsutism, acne and menstrual irregularity in adolescent girls. Here, we propose that the disorder frequently originates from an absolute or relative excess of lipids in adipose tissue, and from associated changes in insulin sensitivity, gonadotropin secretion and ovarian androgen release. Girls from populations with genotypes attuned to nutritionally harsh conditions seem to be particularly vulnerable to the development of hyperinsulinaemic androgen excess in today's obesogenic environment. We propose that hirsutism, hyperandrogenaemia and menstrual irregularity (≥2 years after menarche) is used as a diagnostic triad for the disorder. No pharmacological therapy has been approved for girls with androgen excess; however, lifestyle intervention is essential to reduce adiposity. In girls without obesity who are not sexually active, insulin sensitization has more broadly normalizing effects than estradiol-progestogen combinations. The early recognition of girls at risk of developing hyperinsulinaemic androgen excess might enable prevention in childhood.
高胰岛素血症性高雄激素血症是少女多毛症、痤疮和月经不规律最常见的原因。在这里，我们提出这种疾病通常源于脂肪组织中脂质的绝对或相对过多，以及与胰岛素敏感性、促性腺激素分泌和卵巢雄激素释放相关的变化。来自适应营养苛刻条件的基因型的女孩似乎特别容易在当今的肥胖环境中发展为高胰岛素血症性高雄激素血症。我们提出，多毛症、高雄激素血症和月经不规律（初潮后≥2 年）被用作该疾病的诊断三联征。目前还没有批准用于治疗高雄激素血症的女孩的药物治疗方法；然而，生活方式干预对于减轻肥胖至关重要。在没有肥胖且没有性生活的女孩中，胰岛素增敏作用比雌二醇-孕激素联合治疗具有更广泛的正常化作用。早期识别有发生高胰岛素血症性高雄激素血症风险的女孩可能有助于在儿童时期进行预防。
