F Visconti, F Garino, G Corneli, M Balbo, C Gottero, D Sansone, S E Oleandri
S.C. Endocrinologia e malattie Metaboliche, ASL Città di Torino, Italy.
Endocr Metab Immune Disord Drug Targets. 2024 Jul 26. doi: 10.2174/0118715303322604240722102207.
Postmenopausal androgen excess often occurs due to the imbalance between the rapid decline in ovarian estrogen and a relatively gradual decline in androgen secretion. The rapid onset of hirsutism, alopecia, and acne, on the other hand, is a rare occurrence and requires further investigation in order to rule out an underlying neoplasm.
A 54-year-old woman arrived at the endocrinology outpatient clinic for the appearance of hirsutism and defluvium capitis in the past 9 months. She had hypertrichosis of the face, trunk, and mammary areolae and reduced timbre of voice. Circulating androgens were higher than normal levels (testosterone: 7.7 ng/mL, DHEAS: 5437 mcg/L, 17-OH-progesterone: 3.1 nmol/L), gonadotropin and prolactin levels were normal, and Nugent test was negative. Abdominal CT scan was negative for adrenal lesions, while transvaginal ovarian ultrasonography revealed a left adnexal formation (19x18x24 mm) compatible with stromal neoplasm. A bilateral hysteroannessiectomy was performed. Histological examination was diagnostic for multiple ovarian Leydig cell tumors.
The most frequent cause of postmenopausal hyperandrogenism is polycystic ovary syndrome. It is necessary to exclude the presence of neoplastic causes (ovarian or adrenal androgen- secreting tumors). In case of marked virilization and severe hyperandrogenism, it is useful to perform transvaginal ultrasonography to search for the presence of ovarian hypertrichosis or androgen-secreting ovarian tumors and a CT/RM scan to study the adrenal glands. The best treatment for hyperandrogenism of neoplastic origin is surgery. Patients who are not candidates for this approach are candidates for therapy with GnRH agonists.
绝经后雄激素过多通常是由于卵巢雌激素快速下降与雄激素分泌相对逐渐下降之间的失衡所致。另一方面，多毛症、脱发和痤疮的迅速出现较为罕见，需要进一步检查以排除潜在的肿瘤。
一名54岁女性因在过去9个月出现多毛症和脱发而前往内分泌门诊就诊。她面部、躯干和乳晕多毛，嗓音变低沉。循环雄激素高于正常水平（睾酮：7.7 ng/mL，硫酸脱氢表雄酮：5437 mcg/L，17-羟孕酮：3.1 nmol/L），促性腺激素和催乳素水平正常，纽金特试验为阴性。腹部CT扫描未发现肾上腺病变，而经阴道卵巢超声检查发现左侧附件有一肿物（19×18×24 mm），符合间质肿瘤。遂行双侧子宫附件切除术。组织学检查诊断为多发性卵巢莱迪希细胞瘤。
绝经后高雄激素血症最常见的原因是多囊卵巢综合征。有必要排除肿瘤性病因（卵巢或肾上腺雄激素分泌肿瘤）的存在。在出现明显男性化和严重高雄激素血症的情况下，行经阴道超声检查以寻找卵巢多毛症或雄激素分泌性卵巢肿瘤的存在，并进行CT/磁共振成像扫描以研究肾上腺是有用的。肿瘤源性高雄激素血症的最佳治疗方法是手术。不适合这种治疗方法的患者可采用促性腺激素释放激素激动剂治疗。
