Rosenfield R L, Lucky A W
University of Chicago Pritzker School of Medicine, Illinois.
Endocrinol Metab Clin North Am. 1993 Sep;22(3):507-32.
Hyperandrogenism must be considered in any girl with premature pubarche, unusual acne, hirsutism, or androgenetic alopecia. An association with menstrual irregularity or obesity should raise the index of suspicion. The most common causes of hyperandrogenism presenting in a teenage girl are functional ovarian hyperandrogenism, one manifestation of which is polycystic ovary syndrome, and functional adrenal hyperandrogenism, which usually seems to be due to an exaggeration of adrenarche. The plasma-free testosterone is a more sensitive indicator of hyperandrogenism than is the total testosterone concentration. The pattern of response of plasma free testosterone, DHEAS, and cortisol to dex-suppression testing can be diagnostic of the source of androgen excess. Treatment, including oral contraceptives, low-dose glucocorticoids, and antiandrogens, should be chosen according to the patient's symptoms and source of androgens and should be combined with traditional therapy for the specific dermatologic disorder.
对于任何出现青春期过早、异常痤疮、多毛症或雄激素性脱发的女孩，都必须考虑高雄激素血症。若伴有月经不规律或肥胖，则应提高怀疑指数。青少年女孩出现高雄激素血症最常见的原因是功能性卵巢高雄激素血症（其中一种表现是多囊卵巢综合征）以及功能性肾上腺高雄激素血症（这通常似乎是由于肾上腺初现提前所致）。游离睾酮血浆水平比总睾酮浓度更能敏感地反映高雄激素血症。游离睾酮血浆水平、硫酸脱氢表雄酮（DHEAS）和皮质醇对地塞米松抑制试验的反应模式可用于诊断雄激素过多的来源。治疗应根据患者的症状、雄激素来源进行选择，包括口服避孕药、低剂量糖皮质激素和抗雄激素药物，并应结合针对特定皮肤病的传统疗法。
