Overview
Female adrenal virilization refers to the development of male physical characteristics in women due to excessive androgen production by the adrenal glands. This can manifest as hirsutism, acne, clitoromegaly, and deepening of the voice.Diagnosis
Evaluation should include a thorough history and physical examination, focusing on the onset and progression of virilizing symptoms 1.
Laboratory assessment is crucial and typically includes measurement of serum total testosterone, dehydroepiandrosterone sulfate (DHEAS), and 17-hydroxyprogesterone (17-OHP) 1.
Imaging studies, such as pelvic ultrasound or CT scan of the adrenal glands, may be indicated to evaluate for adrenal tumors or hyperplasia 1.Management
Treatment aims to suppress androgen production and manage symptoms.
First-line medical therapy often involves oral contraceptives to suppress gonadotropin secretion and reduce ovarian androgen production 1.
Anti-androgen medications, such as spironolactone or finasteride, may be used adjunctively 1.
Glucocorticoids are indicated for congenital adrenal hyperplasia (CAH) to suppress ACTH and adrenal androgen synthesis 1.
Surgical intervention, such as adrenalectomy, may be considered for androgen-secreting adrenal tumors 1.Special Populations
Pregnancy: Management during pregnancy requires careful consideration to balance maternal virilization with potential fetal effects 1.Key Recommendations
Measure serum DHEAS and testosterone to evaluate for adrenal or ovarian androgen excess 1. (Evidence: Moderate)
Consider measurement of 17-OHP to screen for non-classic congenital adrenal hyperplasia 1. (Evidence: Moderate)
Oral contraceptives are a cornerstone of medical management for hyperandrogenism in women 1. (Evidence: Moderate)References
1 Auchus RJ, Wilson JD. The life and scientific contributions of Keith L. Parker, 1953-2008. Molecular and cellular endocrinology 2011. link