O'Driscoll J B, Mamtora H, Higginson J, Pollock A, Kane J, Anderson D C
Department of Radiology, Skin Hospital, Salford.
Clin Endocrinol (Oxf). 1994 Aug;41(2):231-6. doi: 10.1111/j.1365-2265.1994.tb02535.x.
To determine the frequency of polycystic ovaries (PCO) on ultrasound and the incidence of clearcut endocrine disorders leading to virilization in patients complaining of hirsutism or androgenic alopecia. The major purpose was to determine a coherent policy for the routine biochemical assessment of such women.
A prospective study of women attending a joint skin/endocrine clinic complaining of these problems.
Three hundred and fifty consecutive women with hirsutism and/or androgenic alopecia were assessed.
Baseline endocrine screens were conducted on two occasions and included measurement of serum testosterone, androstenedione, dehydroepiandrosterone sulphate, sex hormone binding globulin, LH, FSH, 17-hydroxyprogesterone and PRL. The ovaries were visualized by high-resolution pelvic ultrasound scanning.
Eight women were identified with relevant endocrine disorders; of these, one was acromegalic and one had a microprolactinoma--in both cases the association may have been fortuitous. Three had clear-cut 21-hydroxylase deficiency, one a rare hepatic enzyme deficiency (11-reductase), one a virilizing adrenal carcinoma and one a Leydig cell tumour. The latter six cases all had persistently elevated levels of serum testosterone (> 5 nmol/l). In all, 13 women had baseline testosterone levels in excess of 5 nmol/l. Polycystic ovaries were present in 81% of the cases who had erratic cycles and 52% of those with regular cycles; PCO were present in two of the women with 21-hydroxylase deficiency and in the woman with 11-oxoreductase deficiency. The Leydig cell tumour (1.2 cm diameter) was not detected on ultrasound or CT scan.
For the exclusion of enzyme deficiencies and virilizing tumours clinical assessment and a single serum testosterone measurement will suffice.
确定超声检查中多囊卵巢（PCO）的出现频率，以及在主诉多毛症或雄激素性脱发的患者中导致男性化的明确内分泌紊乱的发生率。主要目的是确定对此类女性进行常规生化评估的连贯策略。
对就诊于皮肤/内分泌联合诊所、主诉上述问题的女性进行前瞻性研究。
对350例连续的多毛症和/或雄激素性脱发女性进行评估。
进行两次基线内分泌筛查，包括测定血清睾酮、雄烯二酮、硫酸脱氢表雄酮、性激素结合球蛋白、促黄体生成素（LH）、促卵泡生成素（FSH）、17-羟孕酮和催乳素（PRL）。通过高分辨率盆腔超声扫描观察卵巢。
8名女性被确定患有相关内分泌紊乱；其中，1名患有肢端肥大症，1名患有微泌乳素瘤——在这两种情况下，这种关联可能是偶然的。3名患有明确的21-羟化酶缺乏症，1名患有罕见的肝脏酶缺乏症（11-还原酶），1名患有男性化肾上腺皮质癌，1名患有睾丸间质细胞瘤。后6例患者的血清睾酮水平持续升高（>5 nmol/L）。共有13名女性的基线睾酮水平超过5 nmol/L。月经周期不规律的患者中81%存在多囊卵巢，月经周期规律的患者中52%存在多囊卵巢；21-羟化酶缺乏症的2名女性和11-氧化还原酶缺乏症的女性中存在多囊卵巢。超声或CT扫描未检测到睾丸间质细胞瘤（直径1.2 cm）。
为排除酶缺乏症和男性化肿瘤，临床评估和单次血清睾酮测量就足够了。
