This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Azziz, R. Articles by Boots, L. R. Search for Related Content PubMed PubMed Citation Articles by Azziz, R. Articles by Boots, L. R.

Androgen Excess in Women: Experience with Over 1000 Consecutive Patients

Departments of Obstetrics and Gynecology (R.A., L.A.S., E.S.K., C.M., J.L., K.C.S., K.T., L.R.B.) and Medicine (R.A.), University of Alabama at Birmingham, Birmingham, Alabama 35233; Caracas Fertility Center (L.A.S.), Caracas, Federal District, Venezuela 1050; and the Health Research Council (C.M.), Mexican Institute of Social Security, Federal District, Mexico City, Mexico

Address all correspondence and requests for reprints to: Ricardo Azziz, M.D., M.P.H., M.B.A., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160 W, Los Angeles, California 90048. E-mail: azzizr{at}cshs.org.

The objective of the present study was to estimate the prevalence of the different pathological conditions causing clinically evident androgen excess and to document the degree of long-term success of suppressive and/or antiandrogen hormonal therapy in a large consecutive population of patients.

All patients presenting for evaluation of symptoms potentially related to androgen excess between October 1987 and June 2002 were evaluated, and the data were maintained prospectively in a computerized database. For the assessment of therapeutic response, a retrospective review of the medical chart was performed, after the exclusion of those patients seeking fertility therapy only, or with inadequate follow-up or poor compliance.

A total of 1281 consecutive patients were seen during the study period. Excluded from analysis were 408 patients in whom we were unable to evaluate hormonal status, determine ovulatory status, or find any evidence of androgen excess. In the remaining population of 873 patients, the unbiased prevalence of androgen-secreting neoplasms was 0.2%, 21-hydroxylase-deficient classic adrenal hyperplasia (CAH) was 0.6%, 21-hydroxylase-deficient nonclassic adrenal hyperplasia (NCAH) was 1.6%, hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome was 3.1%, idiopathic hirsutism was 4.7%, and polycystic ovary syndrome (PCOS) was 82.0%. Fifty-nine (6.75%) patients had elevated androgen levels and hirsutism but normal ovulation. A total of 257 patients were included in the assessment of the response to hormonal therapy. The mean duration of follow-up was 33.5 months (range, 6–155). Hirsutism improved in 86%, menstrual dysfunction in 80%, acne in 81%, and hair loss in 33% of patients. The major side effects noted were irregular vaginal bleeding (16.1%), nausea (13.0%), and headaches (12.6%); only 36.6% of patients never complained of side effects.

In this large study of consecutive patients presenting with clinically evident androgen excess, specific identifiable disorders (NCAH, CAH, HAIRAN syndrome, and androgen-secreting neoplasms) were observed in approximately 7% of subjects, whereas functional androgen excess, principally PCOS, was observed in the remainder. Hirsutism, menstrual dysfunction, or acne, but not alopecia, improved in the majority of patients treated with a combination suppressive therapy; although more than 60% experienced side effects.

This work was supported in part by National Institutes of Health Grants RO1-HD29364 and K24-D01346 (to R.A.).

Abbreviations: ASN, Androgen-secreting neoplasm; BMI, body mass index; BTB, breakthrough bleeding; CAH, classic adrenal hyperplasia; DHEAS, dehydroepiandrosterone sulfate; FAE, functional androgen excess; GLU, glucose; HA, hyperandrogenemia; HAIRAN, hyperandrogenic insulin-resistant acanthosis nigricans; HOMA, homeostatic model assessment method; HOMA-%ß-cell, percentage of ß-cell function calculated by HOMA; HOMA-IR, insulin resistance calculated by HOMA; 17-HP, 17-hydroxyprogesterone; IH, idiopathic hirsutism; INS, insulin; mF-G, modified Ferriman-Gallwey; NCAH, non-classic adrenal hyperplasia; OC, oral contraceptive; 21-OH, 21-hydroxylase; PCOS, polycystic ovary syndrome; P4, progesterone; SPA, spironolactone; T, testosterone; WHR, waist to hip ratio.

This article has been cited by other articles:

				B. O. Yildiz, S. Bolour, K. Woods, A. Moore, and R. Azziz Visually scoring hirsutism Hum. Reprod. Update, June 30, 2009; (2009) dmp024v1. [Abstract] [Full Text] [PDF]

				M. Bidet, C. Bellanne-Chantelot, M.-B. Galand-Portier, V. Tardy, L. Billaud, K. Laborde, C. Coussieu, Y. Morel, C. Vaury, J.-L. Golmard, et al. Clinical and Molecular Characterization of a Cohort of 161 Unrelated Women with Nonclassical Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency and 330 Family Members J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1570 - 1578. [Abstract] [Full Text] [PDF]

				C. B d'Alva, G. Abiven-Lepage, V. Viallon, L. Groussin, M. A. Dugue, X. Bertagna, and J. Bertherat Sex steroids in androgen-secreting adrenocortical tumors: clinical and hormonal features in comparison with non-tumoral causes of androgen excess Eur. J. Endocrinol., November 1, 2008; 159(5): 641 - 647. [Abstract] [Full Text] [PDF]

				S Cupisti, N Kajaia, R Dittrich, H Duezenli, M W Beckmann, and A Mueller Body mass index and ovarian function are associated with endocrine and metabolic abnormalities in women with hyperandrogenic syndrome Eur. J. Endocrinol., May 1, 2008; 158(5): 711 - 719. [Abstract] [Full Text] [PDF]

				K. A. Martin, R. J. Chang, D. A. Ehrmann, L. Ibanez, R. A. Lobo, R. L. Rosenfield, J. Shapiro, V. M. Montori, and B. A. Swiglo Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1105 - 1120. [Abstract] [Full Text] [PDF]

				H. F. Escobar-Morreale, R. Sanchon, and J. L. San Millan A Prospective Study of the Prevalence of Nonclassical Congenital Adrenal Hyperplasia among Women Presenting with Hyperandrogenic Symptoms and Signs J. Clin. Endocrinol. Metab., February 1, 2008; 93(2): 527 - 533. [Abstract] [Full Text] [PDF]

				R. Azziz Diagnosing the diagnosis: why we must standardize the defining features of polycystic ovary syndrome Ann Clin Biochem, January 1, 2008; 45(1): 3 - 5. [Full Text] [PDF]

				B. O. Yildiz, E. S. Knochenhauer, and R. Azziz Impact of Obesity on the Risk for Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 162 - 168. [Abstract] [Full Text] [PDF]

				N. Kajaia, H. Binder, R. Dittrich, P. G Oppelt, B. Flor, S. Cupisti, M. W Beckmann, and A. Mueller Low sex hormone-binding globulin as a predictive marker for insulin resistance in women with hyperandrogenic syndrome Eur. J. Endocrinol., October 1, 2007; 157(4): 499 - 507. [Abstract] [Full Text] [PDF]

				M. Luque-Ramirez, F. Alvarez-Blasco, J. I. Botella-Carretero, E. Martinez-Bermejo, M. A. Lasuncion, and H. F. Escobar-Morreale Comparison of Ethinyl-Estradiol Plus Cyproterone Acetate Versus Metformin Effects on Classic Metabolic Cardiovascular Risk Factors in Women with the Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., July 1, 2007; 92(7): 2453 - 2461. [Abstract] [Full Text] [PDF]

				K. Duxbury, L. Gallagher, and B. Keevil The Impact of Simultaneous Measurement of Testosterone and Androstenedione in Women with Suspected Androgen Excess Clin. Chem., April 1, 2007; 53(4): 804 - 805. [Full Text] [PDF]

				R. Azziz, E. Carmina, D. Dewailly, E. Diamanti-Kandarakis, H. F. Escobar-Morreale, W. Futterweit, O. E. Janssen, R. S. Legro, R. J. Norman, A. E. Taylor, et al. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4237 - 4245. [Abstract] [Full Text] [PDF]

				H. Atmaca, F. Tanriverdi, K. Unluhizarci, F. Bayram, and F. Kelestimur Investigation of adrenal functions in patients with idiopathic hyperandrogenemia. Eur. J. Endocrinol., August 1, 2006; 155(2): 307 - 311. [Abstract] [Full Text] [PDF]

				C. M. DeUgarte, K. S. Woods, A. A. Bartolucci, and R. Azziz Degree of Facial and Body Terminal Hair Growth in Unselected Black and White Women: Toward a Populational Definition of Hirsutism J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1345 - 1350. [Abstract] [Full Text] [PDF]

				E. Carmina, F. Rosato, A. Janni, M. Rizzo, and R. A. Longo Relative Prevalence of Different Androgen Excess Disorders in 950 Women Referred because of Clinical Hyperandrogenism J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 2 - 6. [Abstract] [Full Text] [PDF]

				N. A. Cataldo, F. Abbasi, T. L. McLaughlin, M. Basina, P. Y. Fechner, L. C. Giudice, and G. M. Reaven Metabolic and ovarian effects of rosiglitazone treatment for 12 weeks in insulin-resistant women with polycystic ovary syndrome Hum. Reprod., January 1, 2006; 21(1): 109 - 120. [Abstract] [Full Text] [PDF]

				R. L. Rosenfield Hirsutism N. Engl. J. Med., December 15, 2005; 353(24): 2578 - 2588. [Full Text] [PDF]

				R. Zhou, I. M. Bird, D. A. Dumesic, and D. H. Abbott Adrenal Hyperandrogenism Is Induced by Fetal Androgen Excess in a Rhesus Monkey Model of Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6630 - 6637. [Abstract] [Full Text] [PDF]

				R. Azziz, C. Marin, L. Hoq, E. Badamgarav, and P. Song Health Care-Related Economic Burden of the Polycystic Ovary Syndrome during the Reproductive Life Span J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4650 - 4658. [Abstract] [Full Text] [PDF]

				J. L. San Millan, J. I. Botella-Carretero, F. Alvarez-Blasco, M. Luque-Ramirez, J. Sancho, P. Moghetti, and H. F. Escobar-Morreale A Study of the Hexose-6-Phosphate Dehydrogenase Gene R453Q and 11{beta}-Hydroxysteroid Dehydrogenase Type 1 Gene 83557insA Polymorphisms in the Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4157 - 4162. [Abstract] [Full Text] [PDF]