Etiology | Clinical features |
Common | |
PCOS | Peripubertal onset of symptoms, oligomenorrhea, obesity, polycystic ovaries on ultrasound. |
Nonclassic 21-hydroxylase deficiency | Similar presentation to PCOS, high serum 17-hydroxyprogesterone concentration, more common in certain ethnic groups. |
Uncommon | |
Classic 21-hydroxylase deficiency | Diagnosed during infancy, ambiguous genitalia. |
Androgen-secreting ovarian tumors (Sertoli-Leydig cell, granulosa-theca cell, hilus cell) | Onset in third decade or later (usually postmenopausal), rapidly progressive hirsutism, virilization. |
Androgen-secreting adrenal tumors | Some women with adrenocortical cancer present with just virilization, but a mixed Cushing's and virilization syndrome is more common. |
Ovarian hyperthecosis | Onset in third decade or later (usually postmenopausal), rapidly progressive hirsutism, virilization. |
Severe insulin-resistance syndromes | Virilization, amenorrhea, infertility, and the ovary shows histologic changes of hyperthecosis. |
Cushing's disease | Corticotroph adenoma secreting ACTH results in excess cortisol and adrenal androgens. |
Drugs | Use of exogenous androgens (testosterone or DHEA) can cause hirsutism and acne. |
Acromegaly | Enlarged jaw (macrognathia) and enlarged, swollen hands and feet, which result in increasing shoe, glove, and ring sizes. Patients with large pituitary tumors may have headaches, visual field defects, and cranial nerve palsies. |
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