Información del artículo
El hiperandrogenismo es un problema endocrinológico frecuente en mujeres adultas. Su manifestación más habitual es el hirsutismo, acompañado o no de trastornos menstruales y con menor frecuencia de virilización. Se presenta un caso clínico de hiperandrogenismo con amenorrea secundaria y virilización en una mujer en edad fértil. Se evalúa el papel de las diferentes determinaciones hormonales y técnicas de imagen en el diagnóstico etiológico de este cuadro.
Palabras clave:
Hiperandrogenismo
Hirsutismo
Tumor secretor de andrógenos.Mielolipoma adrenal
Hyperandrogenism is one of the most common endocrine diseases affecting adult women. Clinical presentation includes hirsutism, with or without menstrual disturbances (oligomenorrhea, amenorrhea) and, less frequently, virilization. We report the case of a woman of reproductive age with hyperandrogenism, secondary amenorrhea, and virilization. The diagnostic role of laboratory tests and imaging techniques is discussed.
Key words:
Hyperandrogenism
Hirsutism
Androgen-secreting tumor
Adrenal myelolipoma
El Texto completo está disponible en PDF
Bibliografía
[1.]
S. Bulun, E. Adashi.
The physiology and pathology of the female reproductive axis.
Williams textbook of endocrinology, pp. 587-664
[2.]
P.M. Haddad, A. Wieck.
Antipsychotic-induced hyperprolactinaemia: mechaniss, clinical features and management.
Drugs, 64 (2004), pp. 2291-2314
[3.]
J. Bobes, M.P. García-Portilla, J. Rejas, G. Hernández, M. García- García, F. Rico-Villademoros, et al.
Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study.
J Sex Marital Ther, 29 (2003), pp. 125-147
[4.]
R.S. McIntyre, D.A. Mancini, S. McCann, J. Srinivasan, S.H. Kennedy.
Valproate, bipolar disorder and polycystic ovarian syndrome.
Bipolar Disord, 5 (2003), pp. 28-35
[5.]
J.I. Isojarvi, E. Tauboll, A.G. Herzog.
Effect of antiepileptic drugs on reproductive endocrine function in individuals with epilepsy.
CNS Drugs, 19 (2005), pp. 207-223
[6.]
R. Azziz, L. Sánchez, E. Knochenhauer, C. Moran, J. Lazenby, K. Stephens, et al.
Androgen excess in women: experience with over 1000 consecutive patients.
J Clin Endocrinol Metab, 89 (2004), pp. 453-462
[7.]
S. Franks.
Adult polycystic ovary syndrome begin in childhood.
Clin Endocrinol Metab, 16 (2002), pp. 263-272
[8.]
D. Ehrmann.
Polycystic ovary syndrome.
N Engl J Med, 352 (2005), pp. 1223-1236
[9.]
C. Manieri, C. Di Bisceglie, R. Fornengo, T. Grosso, E. Zumpano, F. Calvo, et al.
Postmenopausal virilization in a woman with gonadotropin dependent ovarian hyperthecosis.
J Endocrinol Invest, 21 (1998), pp. 128-132
[10.]
J.H. Barth, M. Jenkins, P.E. Belchetz.
Ovarian hyperthecosis, diabetes and hirsuties in postmenopausal women.
Clin Endocrinol (Oxf), 46 (1997), pp. 123-128
[11.]
P. Speiser, P. White.
Congenital adrenal hyperplasia.
N Engl J Med, 349 (2003), pp. 776-788
[12.]
R. Azziz, E. Carmina, M. Sawaya.
Idiopathic hirsutism.
Endocr Rev, 21 (2000), pp. 347-362
[13.]
C. Friedman, G. Schmidt, M. Kim, J. Powell.
Serum testosterone concentrations in the evaluation of androgen-producing tumors.
Am J Obstet Gynecol, 153 (1985), pp. 44-49
[14.]
W. Waggoner, L. Boots, R. Azziz.
Total testosterone and DHEAS levels as predictors of androgen-secreting neoplasms: a populational study.
Gynecol Endocrinol, 13 (1999), pp. 394-400
[15.]
J. Aiman, C. Edman, R. Worley, F. Vellios, P. MacDonald.
Androgen and estrogen formation in women with ovarian hyperthecosis.
Obstet Gynecol, 51 (1978), pp. 1-9
[16.]
R. Lobo.
Ovarian hyperandrogenism and androgen-producing tumors.
Endocrinol Metab Clin North Am, 20 (1991), pp. 773-805
[17.]
E. Nichelson, R. Toffle.
Hyperandrogenemia associated with insulin resistance mimicking an androgen producing tumor.
W V Med J, 98 (2002), pp. 61-62
[18.]
C. Sawetawan, W. Rainey, R. Word, B. Carr.
Immunohistochemical and biochemical analysis of a human Sertoli-Leydig cell tumor: autonomous steroid production characteristic of ovarian theca cells.
J Soc Gynecol Investig, 2 (1995), pp. 30-37
[19.]
R. Wiebe, C. Morris.
Testosterone/androstenedione ratio in the evaluation women with ovarian androgen excess.
Obstet Gynecol, 61 (1983), pp. 279-284
[20.]
E. Surrey, D. Ziegler, J. Gambone, H. Judd.
Preoperative localization of androgen-secreting tumors: Clinical, endocrinologic, and radiologic evaluation of ten patients.
Am J Obstet Gynecol, 158 (1988), pp. 1313-1322
[21.]
J. Derksen, S. Nagesser, A. Meinders, H. Haak, C. Van de Velde.
Identification of virilizing adrenal tumors in hirsute women.
N Engl J Med, 331 (1994), pp. 968-973
[22.]
A. Bennet.
Hirsutism and hypertrichosis in adults; investigations and treatment.
Ann Dermatol Venereol, 129 (2002), pp. 804-812
[23.]
R. Azziz, L. Hincapié, E. Knochenhauer, D. Dewailly, L. Fox, L. Boots.
Screening for 21-hydroxylase-deficient nonclassic adrenal hyperplasia among hyperandrogenic women: a prospective study.
Fertil Steril, 72 (1999), pp. 915-925
[24.]
P. Speiser.
Congenital adrenal hyperplasia owing to 21-hydroxylase deficiency.
Endocrinol Metab Clin North Am, 30 (2001), pp. 31-59
[25.]
P. White.
Steroid 11βhidroxilase deficiency and related disorders.
Endocrinol Metab Clin North Am, 30 (2001), pp. 61-79
[26.]
R. Rittmaster.
Androgen conjugates: physiology and clinical significance.
Endocr Rev, 14 (1993), pp. 121-132
[27.]
A. Dunaif.
Insulin resistance in polycystic ovarian syndrome.
Ann NY Acad Sci, 687 (1993), pp. 60-64
[28.]
R. Chang, S. Katz.
Diagnosis of polycystic ovary syndrome.
Endocrinol Metab Clin North Am, 28 (1999), pp. 397-408
[29.]
L. Kennedy, A. Traub, A. Atkinson, B. Sheridan.
Short term administration of gonadotropin-releasing hormone analog to a patient with a testosterone-secreting ovarian tumor.
J Clin Endocrinol Metab, 64 (1987), pp. 1320-1322
[30.]
F. Loszio, S. Toth, J. Kocsis, Pavo, M. Szecsi.
Testosterone-secreting gonadotropin-responsive adrenal adenoma and its treatment with the antiandrogen flutamide.
J Endocrinol Invest, 24 (2001), pp. 622-627
[31.]
K. Danilowicz, N. Albiger, M. Vanegas, R. Gómez, G. Cross, O. Bruno.
Androgen-secreting adrenal adenomas.
Obstet Gynecol, 100 (2002), pp. 1099-1102
[32.]
G. Kaltsas, A. Isidori, B. Kola, R. Skelly, S. Chew, P. Jenkins, et al.
The value of the low-dose dexamethasone suppression test in the differential diagnosi of hyperandorgenism in women.
J Clin Endocrinol Metab, 88 (2003), pp. 2634-2643
[33.]
D. Soranno, V. Prasad, R. David, S. Oberfield, A. Greco, N. Sivaraman, et al.
Hypertension and virilization caused by a unique desoxycorticosterone and androgen- secreting adrenal adenoma.
J Pediatr Endocrinol Metab, 12 (1999), pp. 215-220
[34.]
H. Wagnerova, I. Lazurova, J. Bober, L. Sokol, M. Zachar.
Adrenal myelolipoma. 6 cases and a review of the literature.
Neoplasma, 51 (2004), pp. 300-305
[35.]
T. Imai, J. Tobinaga, T. Morita-Matsuyama, T. Kikumori, H. Sasano, H. Seo, et al.
Virilizing adrenocortical adenoma: in vitro steroidogenesis, immunohistochemical studies of steroidogenic enzymes, and gene expression of corticotropin receptor.
Surgery, 125 (1999), pp. 396-402
[36]
NIH State of the Science statement on management of the clinically inapparent adrenal mass (“incidentaloma”). NIH Consens State Sci Statements. 2002;19:1-25.
[37.]
M. Rumbach, B. Biller, G. Braunstein, K. Campbell, J. Carney, P. Godley, et al.
Management of the clinically inapparent adrenal mass (“incidentaloma”).
Ann Intern Med, 138 (2003), pp. 424-429
[38.]
G. Kaltsas, J. Mukherjee, B. Kola, A. Isidori, J. Hanson, J. Dacie, et al.
Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?.
Clin Endocrinol, 59 (2003), pp. 34-43
[39.]
I. Weiss.
Comparative histologic study of 43 metastasizing and nonmetastasizing adrenocortical tumors.
Am J Surg Pathol, 8 (1984), pp. 163-169
[40.]
C. Gicquel, X. Bertagna, V. Gaston, J. Coste, A. Louvel, E. Baudin, et al.
Molecular markers and long-term recurrences in a large cohort of patients with sporadic adrenocortical tumors.
Cancer Res, 61 (2001), pp. 6762-6767
[41.]
S. Aubert, A. Wacrenier, S. Leroy, P. Devos, B. Carnaille, C. Proye, et al.
Weiss system revisited: a clinicopathologic and immunohistochemical study of 49 adrenocortical tumors.
Am J Surg Pathol, 26 (2002), pp. 1612-1619
[42.]
A. Lucon, M. Pereira, B. Mendonca, M. Zerbini, L. Saldanha, S. Arap.
Adrenocortical tumors: results of treatment and study of Weiss’score as a prognostic factor.
Rev Hosp Clin Fac Med Sao Paulo, 57 (2002), pp. 251-256
[43.]
S. Moreno, G. Montoya, J. Armstrong, E. Leteurtre, S. Aubert, M. Vantyghem, et al.
Profile and outcome of pure androgen-secreting adrenal tumors in women: experience of 21 cases.
Surgery, 136 (2004), pp. 1192-1198
Copyright © 2006. Sociedad Española de Endocrinología y Nutrición