Tags

Type your tag names separated by a space and hit enter

Androgen excess: Investigations and management.
Best Pract Res Clin Obstet Gynaecol. 2016 Nov; 37:98-118.BP

Abstract

Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in, or contributes to, the clinical phenotype of these patients. Although AE will contribute to the ovulatory and menstrual dysfunction of these patients, the most recognizable sign of AE includes hirsutism, acne, and androgenic alopecia or female pattern hair loss (FPHL). Evaluation includes not only scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method but also recording and possibly scoring acne and alopecia. Moreover, assessment of biochemical hyperandrogenism is necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly dehydroepiandrosterone sulfate (DHEAS) and androstenedione, although these latter contribute limitedly to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the two. Medical treatment should be combined with cosmetic treatment including topical eflornithine hydrochloride and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) cosmetic treatments. Generally, acne responds to therapy relatively rapidly, whereas hirsutism is slower to respond, with improvements observed as early as 3 months, but routinely only after 6 or 8 months of therapy. Finally, FPHL is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy for an observable response.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta State University, 1120 15th Street, 30912 Augusta, GA, USA; Medical Company IDK, ul. Entuziastov 29, 443067 Samara, Russian Federation; Department of Reproductive Health Protection, Scientific Center of Family Health and Human Reproduction, ul. Timiryazeva 16, 664003 Irkutsk, Russian Federation.Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta State University, 1120 15th Street, 30912 Augusta, GA, USA.Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta State University, 1120 15th Street, 30912 Augusta, GA, USA.Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta State University, 1120 15th Street, 30912 Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta State University, 1120 15th Street, 30912 Augusta, GA, USA. Electronic address: razziz@augusta.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27387253

Citation

Lizneva, Daria, et al. "Androgen Excess: Investigations and Management." Best Practice & Research. Clinical Obstetrics & Gynaecology, vol. 37, 2016, pp. 98-118.
Lizneva D, Gavrilova-Jordan L, Walker W, et al. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol. 2016;37:98-118.
Lizneva, D., Gavrilova-Jordan, L., Walker, W., & Azziz, R. (2016). Androgen excess: Investigations and management. Best Practice & Research. Clinical Obstetrics & Gynaecology, 37, 98-118. https://doi.org/10.1016/j.bpobgyn.2016.05.003
Lizneva D, et al. Androgen Excess: Investigations and Management. Best Pract Res Clin Obstet Gynaecol. 2016;37:98-118. PubMed PMID: 27387253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Androgen excess: Investigations and management. AU - Lizneva,Daria, AU - Gavrilova-Jordan,Larisa, AU - Walker,Walidah, AU - Azziz,Ricardo, Y1 - 2016/05/19/ PY - 2016/04/21/received PY - 2016/05/05/accepted PY - 2016/7/9/pubmed PY - 2017/3/16/medline PY - 2016/7/9/entrez KW - PCOS KW - acne KW - female pattern hair loss KW - hirsutism KW - hyperandrogenism SP - 98 EP - 118 JF - Best practice & research. Clinical obstetrics & gynaecology JO - Best Pract Res Clin Obstet Gynaecol VL - 37 N2 - Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in, or contributes to, the clinical phenotype of these patients. Although AE will contribute to the ovulatory and menstrual dysfunction of these patients, the most recognizable sign of AE includes hirsutism, acne, and androgenic alopecia or female pattern hair loss (FPHL). Evaluation includes not only scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method but also recording and possibly scoring acne and alopecia. Moreover, assessment of biochemical hyperandrogenism is necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly dehydroepiandrosterone sulfate (DHEAS) and androstenedione, although these latter contribute limitedly to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the two. Medical treatment should be combined with cosmetic treatment including topical eflornithine hydrochloride and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) cosmetic treatments. Generally, acne responds to therapy relatively rapidly, whereas hirsutism is slower to respond, with improvements observed as early as 3 months, but routinely only after 6 or 8 months of therapy. Finally, FPHL is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy for an observable response. SN - 1532-1932 UR - https://www.unboundmedicine.com/medline/citation/27387253/Androgen_excess:_Investigations_and_management_ DB - PRIME DP - Unbound Medicine ER -