What Is Hyperandrogenism?

About 34% were from polycystic ovary syndrome, followed by hyperadrenocortical function, which accounted for 29%. A few were found in follicular membrane hyperplasia and adrenal hyperplasia; about 28% were unknown. Recently it has been reported that hyperinsulinemia can stimulate the ovaries to secrete a large amount of androgens and become hypertestosterone.

Hyperandrogenemia

In the follicular phase of a normal menstrual cycle, the average serum testosterone concentration is 0.43ng / ml, and the upper limit is 0.68ng / ml. If it exceeds 0.7ng / m1 (equal to 2.44nmol / L), it is called hypertestosteroneemia, or hyperandrogen Bloodemia. The ovaries and adrenal cortex can synthesize cholesterol from acetic acid, or absorb cholesterol from blood as a matrix, synthesize steroid hormones, and secrete them into the blood circulation. Hypertestosterone, which is the formation of these hormones, especially testosterone in the blood is too high.

Causes of hyperandrogenemia

Pathogenesis of hyperandrogenemia

Androgen in blood circulation mainly includes dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione (4A), testosterone (T) and dihydrotestosterone (DHT).

Causes of high blood androgen: due to excessive secretion of ovaries or adrenal cortex. It may also be caused by abnormal peripheral transformation. The enzyme system is disordered during the biosynthesis of steroid hormones, such as the lack of aromatase, androstenedione cannot be converted into estrone, and testosterone cannot be converted into estradiol, which causes androstenedione, especially testosterone accumulation. excess. 60% of testosterone binds to beta globulin in the blood, called testosterone-estradiol-binding globulin (TEBG), about 38% (mainly androstenedione) binds to albumin, and free testosterone only accounts for 2%. But it is active. If TEBG increases estradiol and decreases testosterone, free testosterone in the blood increases. Hyperinsulinemia caused by insulin resistance can stimulate the ovaries to secrete a large amount of androgens.

Causes of infertility caused by hypertestosterone: The ovaries and adrenals secrete too many hormones, which are converted to estrone by aromatase in the peripheral adipose tissue through blood circulation. Excessive estrone continues to affect the hypothalamus and pituitary gland. Positive feedback on LH secretion and negative feedback on FSH secretion resulted in high LH levels and low FSH levels without periodic fluctuations. LH / FSH ratio increased by 2 ~ 3. Low FSH causes follicles to develop to a certain degree, but cannot mature; LH secretion increases continuously, but there is no periodic fluctuation, that is, there is no LH peak. As a result, ovulation does not occur, leading to infertility.

Clinical manifestations of hyperandrogenemia

More common are menstrual changes such as thin menstruation, amenorrhea or dysfunctional uterine bleeding, non-ovulation, infertility. Some have virilization changes, such as hairiness, enlarged larynx, and low pitch. Some have obesity, acne, poor breast growth, poor uterine development, enlarged ovaries, and a few cases with enlarged clitoris.

Diagnosis of hyperandrogenemia

1. According to clinical manifestations, especially those with thin menstrual periods, amenorrhea or dysfunctional uterine bleeding, plus certain virilization manifestations, the possibility of this disease should be considered. The diagnosis is based on an increase in blood testosterone> 7.0 ng / m1 or 2.44 nmol / L.

2. In order to identify the disease originating from the ovary or adrenal cortex, an ACTH excitation test can be used: intramuscular injection of 20 mg ACTH, and urine 17-ketone and 17-hydroxysteroid excretion are measured 24 hours before and after injection. If the excretion is significantly increased after injection, the adrenal cortex function is abnormal; if there is no significant change in excretion before and after injection, it indicates that the lesion is in the ovary.

3 B-ultrasound can measure the ratio of ovarian size to uterine size. Those with ovaries larger than 1/4 of the uterine body can be considered as polycystic ovary.

4 Clomiphene treatment test: Take clomiphene continuously for 3 cycles. If the ovulation is mostly polycystic ovary, if there is no ovulation in 3 cycles, you can consider the follicular membrane hyperplasia.

5. Intraventricular angiography, the size and shape of the adrenal glands can be checked to distinguish adrenal hyperplasia or hyperfunction.

6. On the 9th day of the menstrual cycle, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), and testosterone (T) were measured by radioimmunoassay or enzyme-labeled method. LH is high, LH / FSH ratio is high, and T is high.

7. Adrenal and ovarian tumors were excluded.

Treatment of hyperandrogens

Western medicine treatment of hyperandrogenemia

1. Spironolactone Spironolactone competes with androgens, especially dihydrotestosterone (DHT), for receptors on target cells, interferes with the formation of normal dihydrotestosterone, and can also inhibit the activity of some enzymes , Interfere with the biosynthesis of testosterone. On the 5th to 21st of the menstrual cycle, 100mg / d for 4 to 6 consecutive cycles, LH and T could drop to normal levels after stopping the drug, while FSH and PRL remained unchanged compared to before treatment. Side effects such as drinking more, urination, fatigue, headache and so on are small and mild, without stopping the medicine.

2. Corticosteroids such as Prednison 5mg, 2 / d; Dexamethasone 0.5-0.75mg, 2 / d, are taken continuously for 3-6 months. The greatest role of corticosteroids is to inhibit the adrenal cortex function and reduce the secretion of dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstenedione (4A), and testosterone (T). It is therefore suitable for hypertestosterone derived from the adrenal glands. The ovulation rate of this product alone is 50%; if combined with clomiphene, the ovulation rate can reach 80% to 100%.

3 Clomiphene can block the abnormal metabolism of steroid hormones. On the 5th day of menstruation, 50 100mg, 1 / d, and continuous administration for 5d will promote the maturation of follicles, ovulation, and the formation of corpus luteum. B-ultrasound monitoring of follicular growth from the 8th day of menstruation. When the maximum diameter of the dominant follicle reaches 18mm, a single intramuscular injection of chorionic gonadotropin (HCG) 5000U can more effectively assist in inducing ovulation and prevent luteal insufficiency in some patients.

4 Urine gonadotropin can increase the activity of aromatase, promote the conversion of androstenedione to estrone, and testosterone to estradiol. Commonly used is human menopausal gonadotropin (HMG). On the 5th day of menstruation, 1-2 intramuscular injections (150 to 300U) daily. When the maximum diameter of dominant follicles reaches 18mm, stop HMG and intramuscular injection of HCG 5000U. To stimulate ovulation. Ultra pure follicle-stimulating hormone (Metrodin) contains only FSH, which is more applicable. Beginning on the 5th day of menstruation, intramuscular injection of 75U once a day. From the 8th day of menstruation, B-ultrasound monitors the growth of follicles. At that time, Metrodin was stopped and another intramuscular injection of HCG 5000U was used to trigger ovulation.

5. Traditional Chinese Medicine Artificial Cycle Therapy

Chinese medicine treatment of hyperandrogenemia

1. Shaoyao Gancao Decoction can reduce T value, convert T to E2, increase FSH / LH ratio, and increase TEBG concentration.

2. TCM syndrome differentiation and treatment are divided into kidney deficiency and essence deficiency, qi stagnation and blood stasis, phlegm dampness block, and liver stagnation and fire type 4; .