Hypertestosteroneemia
Introduction
Introduction to high testosteroneemia In the follicular phase of the normal menstrual cycle, the serum testosterone concentration is 0.43 ng/ml on average, and the upper limit is 0.68 ng/ml. If it exceeds 0.7 ng/m1 (equal to 2.44 nmol/L), it is called high testosteroneemia, or high androgen. Blood. Ovarian, adrenal cortex, etc. can synthesize cholesterol from acetic acid, or absorb cholesterol from the blood as a matrix, synthesize steroid hormones, and secrete into the blood circulation. High testosteroneemia, which is formed by the high levels of these hormones, especially testosterone in the blood. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: amenorrhea infertility
Cause
Cause of high testosteroneemia
Cause
About 34% of patients with polycystic ovary syndrome, followed by adrenal hyperfunction, accounting for 29%, a small number of follicular hyperplasia and adrenal hyperplasia; about 28% of unknown sources. It has recently been reported that hyperinsulinemia can stimulate the ovary to secrete large amounts of androgen into hypertestosterone.
Pathogenesis
The androgens in the blood circulation are mainly DHEAS, DHEA, androstenedione (4A), testosterone (T) and dihydrotestosterone (DHT).
Causes of high blood androgen: 1 due to excessive secretion of ovary or adrenal cortex. 2 may also be caused by abnormal peripheral transformation. 3 is the enzyme system disorder in the process of steroid hormone biosynthesis, such as aromatase deficiency, androstenedione can not be converted to estrone, testosterone can not be converted to estradiol, androstenedione, especially testosterone accumulation excess. 460% 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 binds to estradiol and the testosterone decreases, the free testosterone in the blood increases. 5 Hyperinsulinemia caused by insulin resistance can stimulate the ovary to secrete a large amount of androgen.
Causes of infertility caused by high testosteroneemia: excessive secretion of hormones by the ovary and adrenal glands, which are converted into estrone by aromatase in peripheral adipose tissue through blood circulation, and excessive estrone continues to act on the hypothalamus and pituitary gland. Positive feedback on the secretion of LH and negative feedback on the secretion of FSH, forming a high LH level without periodic fluctuations, low FSH level. The LH/FSH ratio is increased by 2~3. Low FSH allows follicles to develop to a certain extent, but not mature; LH sustained secretion increases, but there is no periodic fluctuation, that is, no LH peak. Therefore, no ovulation, resulting in infertility.
Prevention
Prevention of high testosteroneemia
Do not blindly tonic: If girls eat a variety of meat, nutrients, foreign fast food, it will lead to high levels of androgen in the body, obesity, rare menstruation, hemorrhoids, etc., medically known as adolescent high testosterone blood disease. If this condition continues into the reproductive age, it can develop into polycystic ovary syndrome and lead to infertility.
Complication
High testosterone complications Complications, amenorrhea, infertility
Causes of infertility caused by high testosteroneemia: excessive secretion of hormones by the ovary and adrenal glands, which are converted into estrone by aromatase in peripheral adipose tissue through blood circulation, and excessive estrone continues to act on the hypothalamus and pituitary gland. Positive feedback on the secretion of LH and negative feedback on the secretion of FSH, forming a high LH level without periodic fluctuations, low FSH level. The LH/FSH ratio is increased by 2~3. Low FSH allows follicles to develop to a certain extent, but not mature; LH sustained secretion increases, but there is no periodic fluctuation, that is, no LH peak. Therefore, no ovulation, resulting in infertility.
Symptom
Symptoms of high testosteroneemia Common symptoms Menstrual rare, non-ovulatory amenorrhea, mammary gland dysplasia, masculinization, abnormal uterine bleeding, obesity, clitoris hypertrophy
Clinical manifestation
More common are menstrual changes such as menstrual thinning, amenorrhea or dysfunctional uterine bleeding, no ovulation, infertility. Some have masculine changes, such as hairy, enlarged throat, and low pitch. Some obesity, hemorrhoids, breast dysplasia, poor uterine development, ovarian enlargement, a few cases of clitoris hypertrophy.
Examine
Examination of high testosteroneemia
1. According to clinical manifestations, especially menstrual thinning, amenorrhea or dysfunctional uterine bleeding, plus some masculine performance should consider the possibility of this disease. The diagnosis is based on an increase in blood testosterone of >7.0 ng/m1 or >2.44 nmol/L.
2. In order to identify the lesion from the ovary or adrenal cortex, ACTH stimulation test can be used: intramuscular injection of ACTH 20mg, urine ketone 17-hydroxyl steroid excretion 24 hours before and after injection. If the excretion after injection is significantly increased, the adrenal cortical function is abnormal; if there is no significant change in excretion before and after injection, the lesion is in the ovary.
3. B-ultrasound can measure the ratio of ovarian size to uterine size. If the ovary is larger than 1/4 of the uterus, it can be considered as polycystic ovary.
4. Clomiphene treatment test: continuous administration of clomiphene for 3 cycles, if the ovulation is mostly polycystic ovary, such as no ovulation in 3 cycles, it can be considered as follicular hyperplasia.
5. Intraperitoneal wall angiography, the size and shape of the adrenal gland can be examined 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 labeling. LH is high, LH/FSH ratio is high, and T is high.
7. Exclude adrenal cortical tumors and ovarian tumors.
Diagnosis
Diagnosis and differentiation of high testosteroneemia
Differential diagnosis of high testosteroneemia:
First, ovarian masculinizing tumors: including support for a stromal cell tumor, portal cell tumor, lipoblastoma, myxoma, adrenal residual tumor, lutocytoma, teratoma and metastatic cancer. In addition to the above-mentioned dystrophic blastoma, other tumors are mostly unilaterally growing solid tumors, and the androgen secretion is autonomic, masculine symptoms are obvious, and often accompanied by ascites and metastases.
Second, adrenal diseases: including congenital adrenal hyperplasia, adenoma and adenocarcinoma. The latter two mainly secrete androstenedione and DHEA, which are also autonomously secreted, not promoted by ACTH and inhibited by dexamethasone. Congenital adrenal hyperplasia, 21 hydroxylase deficiency, typical vulvar-genitourinary sinus malformation with dysplasia.
Third, thyroid disease: including hyperthyroidism and hypothyroidism. At the time of hyperthyroidism, T3, T4, and SHBG increased, and the androgen clearance rate decreased, which caused the increase of plasma testosterone to cause masculinization and menstrual disorders. When hypothyroidism occurs, the conversion of androgens to estrogen increases to cause anovulation.
Fourth, hereditary hirsutism: a family history, only simple hairy without PCOS symptoms and signs. Fertility is normal.
V. Ovarian follicular cell hyperplasia: The gonadotropin secretion is normal, the ovary does not increase, but the follicular cells are nest (island) hyperplasia, and the plasma androgen is elevated significantly, with severe masculinization. Not sensitive to chlorophenolamine treatment.
Sixth, insulin anti-allergic syndrome and melanin acanthoma: an adiponectin receptor-deficient disease (A / B type), can appear similar to PCOS symptoms and signs. Its prominent features are hyperinsulinemia and melanoma of the neck and palate.
Seven, hyperprolactinemia: amenorrhea, galactorrhea, infertility, PRL and DHEAS increased, masculine symptoms are not obvious, ovarian normal.
According to clinical manifestations, especially menstrual thinning, amenorrhea or dysfunctional uterine bleeding, plus some masculinity characteristics should consider the possibility of this disease. The diagnosis is based on an increase in blood testosterone >0.7 ng/ml or >2.44 nmol/L. Others, such as B-ultrasound, clomiphene test and other auxiliary examinations can assist in diagnosis.
