Postmenopausal hyperthecosis: functional dysregulation of androgenesis in climacteric ovary.
ABSTRACT Hyperandrogenism of ovarian origin is rare in postmenopausal women. However, there is evidence that the ovaries of postmenopausal women are active endocrine glands, secreting mainly androgens.
A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended. However, surgery had to be withheld for 6 months while the patient recovered from an acute myocardial infarction. In the interim, the patient's hyperandrogenemia was successfully treated with monthly injections of the gonadotropin-releasing hormone agonist (GnRH), leuprolide acetate.
This report illustrates the potential for postmenopausal ovaries to become active androgen-secreting endocrine organs. It also demonstrates the efficacy of pharmacologic intervention for postmenopausal ovarian hyperthecosis when the patient is a poor surgical candidate.
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ABSTRACT: Endocrine changes supervening after parturition and menopause participate in the control of sebum production and hair growth modulation. The ensuing conditions include some peculiar aspects of hair loss (effluvium), alopecia, and facial hirsutism. The hair cycling is of major clinical relevance because most hair growth disorders result from disturbances in this chronobiological feature. Of note, any correlation between a biologic abnormality and hair cycling disturbance does not prove a relationship of causality. The proportion of postmenopausal women is rising in the overall population. Therefore, the prevalence of these hair follicle disturbances is globally on the rise. Current therapies aim at correcting the underlying hormonal imbalances, and at improving the overall cosmetic appearance. However, in absence of pathogenic diagnosis and causality criteria, chances are low that a treatment given by the whims of fate will adequately control hair effluvium. The risk and frequency of therapeutic inertia are further increased. When the hair loss is not controlled and/or compensated by growth of new hairs, several clinical aspects of alopecia inexorably develop. Currently, there is little evidence supporting any specific treatment for these endocrine hair disorders in post-partum and postmenopausal women. Current hair treatment strategies are symptomatic and nonspecific so current researchers aim at developing new, targeted methods.BioMed research international. 12/2013; 2013:957432.
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ABSTRACT: Mild clinical signs of hyperandrogenism such as hirsutism may appear during the menopausal transition as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. We report a case of a 68-year-old woman with signs of virilization that had started 6 months before. Clinical analyses revealed high levels of serum testosterone for a postmenopausal woman. Pelvic MRI and abdomen CT showed no evidence of ovarian and adrenal tumor. Postmenopausal hyperandrogenism can be the result of numerous etiologies ranging from normal physiologic changes to ovarian or rarely adrenal tumors. Our patient was found to have iatrogenic hyperandrogenism. This condition is rarely reported cause of virilization.Case reports in endocrinology. 01/2014; 2014:987272.
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ABSTRACT: Women in their fourth decade and older experience a decrease in androgen serum levels. This may lead to the clinical syndrome of female androgen insufficiency expressed by insidious tiredness, diminished sense of well-being and libido, alterations in body composition and bone loss. If there is a past history of bilateral oophorectomy, hypopituitarysm, androgen adrenal supression and/or free testosterone serum levels are low, it is probable that these signs and symptoms could be relieved by a discerning androgen administration, which has been largely accepted. When current recommended doses are used, it appears that the benefits regarding bone mass, sexuality and well-being may be achieved without important signs of masculinizing. Nonetheless, it is necessary to conduct well-controlled, long-term studies, in order to validate the hypothesis that therapeutic administration of androgens to women does not lead to an increased incidence of breast cancer or metabolic complications.Arquivos Brasileiros de Endocrinologia & Metabologia 04/2005; 49(2):205-216. · 0.68 Impact Factor