Medenica Sanja, Zivanovic Dusan, Milardi Domenico, Bruno Carmine, Batkoska Ljubica, Traini Emanuela, Pontecorvi Alfredo
Department of Endocrinology, Internal Medicine Clinic, Clinical Center of Montenegro, School of Medicine, University of Montenegro, 81000 Podgorica, Montenegro.
Clinic of Endocrinology, Diabetes and Metabolic Disorders, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Life (Basel). 2024 Mar 9;14(3):360. doi: 10.3390/life14030360.
Hyperandrogenism is a condition in which the levels of androgen hormones in the blood are significantly increased and could be of an adrenal or ovarian origin. The adrenal androgens, normally secreted by the zona reticularis, are steroid hormones with weak androgen activity. The causes of hyperandrogenism are diverse and could be endogenous and exogenous. Androgen excess affecting different tissues and organs results in clinical features such as acne, hirsutism, virilization, and reproductive dysfunction such as oligomenorrhoea/amenorrhoea. Although androgen excess is rarely associated with adrenal tumours, it is important as it could be predictive of malignancy. A careful evaluation of the androgen pattern, also in patients with clear signs of hyperandrogenism, could be useful. Laboratory evaluation should focus on measuring total testosterone levels, followed by the estimation of other androgens such as dehydroepiandrosterone and androstenedione, and using visualisation procedures in the further management. The treatment of adrenal hyperandrogenism is eminently surgical, in consideration of the frequent malignant origin. The aim of this review is to elaborate and summarize the prevalence and clinical management of hyperandrogenism of an adrenal origin by describing the physiological mechanisms of adrenal androgen steroidogenesis, the clinical manifestations of hyperandrogenism with a special reference to hyperandrogenism in adrenal adenomas and carcinomas, and the diagnostic methods that will lead us to establishing the correct diagnosis and different treatment options to manage this condition according to the clinical presentation of the patient.
高雄激素血症是一种血液中雄激素水平显著升高的病症，其病因可能源于肾上腺或卵巢。肾上腺雄激素通常由网状带分泌，是具有弱雄激素活性的类固醇激素。高雄激素血症的病因多种多样，可分为内源性和外源性。雄激素过多会影响不同组织和器官，导致痤疮、多毛症、男性化以及诸如月经过少/闭经等生殖功能障碍等临床特征。尽管雄激素过多很少与肾上腺肿瘤相关，但因其可能预示恶性肿瘤，所以很重要。对雄激素模式进行仔细评估，即便对于有明显高雄激素血症迹象的患者也可能有用。实验室评估应着重测量总睾酮水平，随后估算其他雄激素，如脱氢表雄酮和雄烯二酮，并在后续管理中采用可视化检查程序。鉴于肾上腺高雄激素血症常常起源于恶性肿瘤，其治疗主要是手术治疗。本综述的目的是通过描述肾上腺雄激素类固醇生成的生理机制、高雄激素血症的临床表现（特别提及肾上腺腺瘤和腺癌中的高雄激素血症）以及有助于我们做出正确诊断的诊断方法，还有根据患者临床表现来管理该病症的不同治疗选择，来阐述和总结肾上腺源性高雄激素血症的患病率及临床管理。
