Hyperandrogenism in Women: Polycystic Ovary Syndrome

Yeon-Ah Sung

doi:10.7599/hmr.2012.32.4.197

Journal List > Hanyang Med Rev > v.32(4) > 1044126

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Sung: Hyperandrogenism in Women: Polycystic Ovary Syndrome

Review Article

Hanyang Medical Reviews

Hanyang Medical Reviews 2012; 32(4): 197-202.

Published online: 28 November 2012

DOI: https://doi.org/10.7599/hmr.2012.32.4.197

Hyperandrogenism in Women: Polycystic Ovary Syndrome

Yeon-Ah Sung

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Yeon-Ah Sung. Department of Internal Medicine, Ewha Mokdong Hospital, A-dong 813-ho, Uihakgwan, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: +82-2-2650-5034, Fax: +82-2-2061-5235, yasung@ewha.ac.kr

Received 18 August 2012 Revised 23 October 2012 Accepted 30 October 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hyperandrogenism refers to classical androgen-dependent signs such as hirsutism, acne and androgenetic alopecia. Disorders that result in androgen excess include specific identifiable disorders (i.e. disorders of inclusion), but the great majority of women presenting with hirsutism and other symptoms or signs of hyperandrogenism suffer from polycystic ovary syndrome (PCOS). Hirsutism is the main hyperandrogenic symptom, defined as an excess of body hair in androgen-sensitive regions of skin in women. In this review, I attempt to focus on the pathogenesis of hirsutism, as well as clinical and biochemical features that are important in choosing therapeutic options. PCOS is the most common disorder of premenopausal women, affecting 4 to 8% of this population, and therefore, diagnostic issues of PCOS in Korean women will be addressed, specifically the reproductive and metabolic derangements and criteria for hyperandrogenism based on hirsutism and serum androgen concentrations.

Keywords: Hyperandrogenism, Hirsutism, Polycystic Ovary Syndrome

Figures and Tables

Fig. 1

Ferriman-Gallwey hirsutism scoring system. Each of the nine body areas most sensitive to androgen is assigned a score from 0 (no hair) to 4 (frankly virile), and these separate scores are summed to provide a hormonal hirsutism score. Ref. 5 with permission from Endocrine Society.

Fig. 2

Suggested algorithm for the initial evaluation of hirsute women for hyperandrogenism. T, testosterone; PCOS, polycystic ovary syndrome; OCP, oral contraceptive pill; AM, before noon. Ref. 5 with permission from Endocrine Society.

Table 1

Etiology of Hirsutism

Table 2

Various Diagnostic Criteria of Polycystic Ovary Syndrome

NICHD, national institute of children's health and disease; ESHRE, european society of human reproduction and embryology; AES, androgen excess society; PCO, polycystic ovary.

References

1. Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004. 89:453–462.

2. Chen WC, Zouboulis CC. Hormones and the pilosebaceous unit. Dermatoendocrinol. 2009. 1:81–86.

3. Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006. 91:2–6.

4. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003. 101:995–1007.

5. Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008. 93:1105–1120.

6. Unluhizarci K, Kaltsas G, Kelestimur F. Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism. Eur J Clin Invest. 2012. 42:86–94.

7. Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011. 7:219–231.

8. Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf). 2000. 52:595–600.

9. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005. 352:1223–1236.

10. Legro RS, Urbanek M, Kunselman AR, Leiby BE, Dunaif A. Self-selected women with polycystic ovary syndrome are reproductively and metabolically abnormal and undertreated. Fertil Steril. 2002. 78:51–57.

11. Legro RS. Polycystic ovary syndrome and cardiovascular disease: a premature association? Endocr Rev. 2003. 24:302–312.

12. Park HR, Oh JY, Hong YS, Sung YA, Lee H, Cheong HW. The clinical characteristics of Korean women with polycystic ovary syndrome. Korean J Med. 2007. 73:169–175.

13. Pyun GW, Choi YJ, Lee H, Oh JY, Hong YS, Sung YA, et al. Phenotypic Variation of Polycystic Ovary Syndrome. J Korean Endocr Soc. 2007. 22:326–331.

14. Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995. 10:2107–2111.

15. Carmina E, Chu MC, Longo RA, Rini GB, Lobo RA. Phenotypic variation in hyperandrogenic women influences the findings of abnormal metabolic and cardiovascular risk parameters. J Clin Endocrinol Metab. 2005. 90:2545–2549.

16. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006. 91:4237–4245.

17. Franks S. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. J Clin Endocrinol Metab. 2006. 91:786–789.

18. Sung YA. Insulin resistance in polycystic ovary syndrome. Korean Diabetes J. 2008. 32:1–6.

19. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol. 1992. 167:1807–1812.

20. DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab. 2006. 91:1345–1350.

21. Landay M, Huang A, Azziz R. Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril. 2009. 92:643–647.

22. Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf). 2005. 62:644–649.

23. Byun EK, Kim HJ, Oh JY, Hong YS, Sung YA. The Prevalence of Polycystic Ovary Syndrome in College Students from Seoul. J Korean Soc Endocrinol. 2005. 20:120–126.

24. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004. 89:2745–2749.

25. Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005. 90:1929–1935.

26. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab. 1999. 84:4006–4011.

27. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000. 85:2434–2438.

28. Kumarapeli V, Seneviratne Rde A, Wijeyaratne CN, Yapa RM, Dodampahala SH. A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka. Am J Epidemiol. 2008. 168:321–328.

29. Cibula D, Cifkova R, Fanta M, Poledne R, Zivny J, Skibova J. Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. Hum Reprod. 2000. 15:785–789.

30. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989. 38:1165–1174.

31. Ehrmann DA, Barnes RB, Rosenfield RL, Cavaghan MK, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999. 22:141–146.

32. Elting MW, Korsen TJ, Bezemer PD, Schoemaker J. Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod. 2001. 16:556–560.

33. Ewens KG, Stewart DR, Ankener W, Urbanek M, McAllister JM, Chen C, et al. Family-based analysis of candidate genes for polycystic ovary syndrome. J Clin Endocrinol Metab. 2010. 95:2306–2315.

34. Chen ZJ, Zhao H, He L, Shi Y, Qin Y, Li Z, et al. Genome-wide association study identifies susceptibility loci for polycystic ovary syndrome on chromosome 2p16.3, 2p21 and 9q33.3. Nat Genet. 2011. 43:55–59.

TOOLS

Similar articles