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Amenorrhea with Cryptic Hyperandrogenemia^*

Department of Endocrinology, Saint Vincent's Hospital, Elm Park, Dublin 4, Ireland; and Department of Medicine, University College, Dublin, Ireland

Address requests for reprints to: T. Joseph McKenna, M.D., Consultant Endocrinologist, Saint Vincent's Hospital, Elm Park, Dublin 4, Ireland.

It is current practice to assume that when menstrual disturbances are associated with androgen excess there will be additional clinical evidence of this. We have recently seen three women with secondary amenorrhea who did not have any other clinical features of androgen excess, i.e. hirsutism, acne, etc., but who had elevated plasma testosterone and androstenedione levels in addition to increased estrone values. Correction of hypertestosteronemia and elevated estrone levels was followed by ovulation, regular menstruation, and pregnancy. Variable tissue sensitivity to androgens probably accounts for these observations. If measurement of androgen levels is omitted in the evaluationof patients with amenorrhea without hirsutism, cryptic hyperandrogenemia will remain undetected. Plasma testosterone levels should be measured in all patients with amenorrhea of unknown etiology, and only if these are normal should a diagnosis of functional amenorrhea be assigned. (J Clin Endocrinol Metab 56: 893, 1983)

^* This work was supported in part by Grant No. 5 ROI12248 awarded by the National Institute of Child Health and Human Development; Dublin, Ireland.

Received June 1, 1982.

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