Division of Endocrinology and Metabolism, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.
Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia.
Semin Reprod Med. 2022 Mar;40(1-02):42-52. doi: 10.1055/s-0041-1742259. Epub 2022 Jan 20.
Hyperandrogenism-clinical features resulting from increased androgen production and/or action-is not uncommon in peripubertal girls. Hyperandrogenism affects 3 to 20% of adolescent girls and often is associated with hyperandrogenemia. In prepubertal girls, the most common etiologies of androgen excess are premature adrenarche (60%) and congenital adrenal hyperplasia (CAH; 4%). In pubertal girls, polycystic ovary syndrome (PCOS; 20-40%) and CAH (14%) are the most common diagnoses related to androgen excess. Androgen-secreting ovarian or adrenal tumors are rare (0.2%). Early pubic hair, acne, and/or hirsutism are the most common clinical manifestations, but signs of overt virilization in adolescent girls-rapid progression of pubic hair or hirsutism, clitoromegaly, voice deepening, severe cystic acne, growth acceleration, increased muscle mass, and bone age advancement past height age-should prompt detailed evaluation. This article addresses the clinical manifestations of and management considerations for non-PCOS-related hyperandrogenism in adolescent girls. We propose an algorithm to aid diagnostic evaluation of androgen excess in this specific patient population.
高雄激素血症-由雄激素产生和/或作用增加引起的临床特征-在青春期前女孩中并不少见。高雄激素血症影响 3%至 20%的青春期女孩，常与高雄激素血症有关。在青春期前女孩中，雄激素过多的最常见病因是早熟性肾上腺皮质功能亢进症（60%）和先天性肾上腺皮质增生症（CAH；4%）。在青春期女孩中，多囊卵巢综合征（PCOS；20%-40%）和 CAH（14%）是与雄激素过多相关的最常见诊断。雄激素分泌性卵巢或肾上腺肿瘤很少见（0.2%）。阴毛早现、痤疮和/或多毛症是最常见的临床表现，但青春期女孩出现明显的男性化迹象-阴毛或多毛症迅速进展、阴蒂肥大、声音变深、严重的囊性痤疮、生长加速、肌肉量增加和骨龄超过身高年龄-应提示进行详细评估。本文介绍了青春期女孩非 PCOS 相关高雄激素血症的临床表现和治疗注意事项。我们提出了一种算法，以帮助诊断评估该特定患者群体的雄激素过多。
