dostęp otwarty

Tom 11, Nr 5 (2017)
Wybrane problemy kliniczne
Opublikowany online: 2017-11-28
Pobierz cytowanie

Hiperandrogenizm u kobiet po menopauzie

Przemysław Kłosowski1, Renata Świątkowska-Stodulska1, Agata Berlińska2, Krzysztof Sworczak1
Forum Medycyny Rodzinnej 2017;11(5):195-208.
Afiliacje
  1. Klinika Endokrynologii I Chorób Wewnętrznych, Gdański Uniwersytet Medyczny, Polska
  2. Wydział Lekarski, Gdański Uniwersytet Medyczny, Polska

dostęp otwarty

Tom 11, Nr 5 (2017)
Wybrane problemy kliniczne
Opublikowany online: 2017-11-28

Streszczenie

Androgeny u kobiet odgrywają ważną rolę. Regulują metabolizm, wpływając na nastrój czy funkcje seksualne. Jednakże ich nadmiar działa negatywne na zdrowie kobiet. Po menopauzie w sposób naturalny dochodzi do przesunięcia równowagi hormonalnej w kierunku hiperandrogenemii. Łagodne objawy hiperandrogenizmu związane z przejściem menopauzalnym muszą być odróżnione od nasilonej hiperandrogenemii, która może mieć podłoże nowotworowe. W niniejszym artykule omówiono zmiany androgenów zachodzące u kobiet po menopauzie, objawy i etiologię hiperandrogenizacji, zaproponowano schemat postępowania diagnostycznego, przedstawiono dostępne metody leczenia, jak również dokonano przeglądu aktualnego piśmiennictwa.

Streszczenie

Androgeny u kobiet odgrywają ważną rolę. Regulują metabolizm, wpływając na nastrój czy funkcje seksualne. Jednakże ich nadmiar działa negatywne na zdrowie kobiet. Po menopauzie w sposób naturalny dochodzi do przesunięcia równowagi hormonalnej w kierunku hiperandrogenemii. Łagodne objawy hiperandrogenizmu związane z przejściem menopauzalnym muszą być odróżnione od nasilonej hiperandrogenemii, która może mieć podłoże nowotworowe. W niniejszym artykule omówiono zmiany androgenów zachodzące u kobiet po menopauzie, objawy i etiologię hiperandrogenizacji, zaproponowano schemat postępowania diagnostycznego, przedstawiono dostępne metody leczenia, jak również dokonano przeglądu aktualnego piśmiennictwa.
Pobierz cytowanie

Słowa kluczowe

menopauza, hiperandrogenizm, wirylizacja, androgeny, testosteron, kobiety po menopauzie

Informacje o artykule
Tytuł

Hiperandrogenizm u kobiet po menopauzie

Czasopismo

Forum Medycyny Rodzinnej

Numer

Tom 11, Nr 5 (2017)

Strony

195-208

Opublikowany online

2017-11-28

Wyświetlenia strony

1538

Wyświetlenia/pobrania artykułu

10340

Rekord bibliograficzny

Forum Medycyny Rodzinnej 2017;11(5):195-208.

Słowa kluczowe

menopauza
hiperandrogenizm
wirylizacja
androgeny
testosteron
kobiety po menopauzie

Autorzy

Przemysław Kłosowski
Renata Świątkowska-Stodulska
Agata Berlińska
Krzysztof Sworczak

Referencje (93)
  1. Cameron DR, Braunstein GD. Androgen replacement therapy in women. Fertil Steril. 2004; 82(2): 273–289.
  2. Burger H. Androgen production in women. Fertil Steril. 2002; 77: 3–5.
  3. Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012; 18(2): 146–170.
  4. Longcope C. Adrenal and gonadal androgen secretion in normal females. Clin Endocrinol Metab. 1986; 15(2): 213–228.
  5. Fogle RH, Stanczyk FZ, Zhang X, et al. Ovarian androgen production in postmenopausal women. J Clin Endocrinol Metab. 2007; 92(8): 3040–3043.
  6. Davison SL, Bell R, Donath S, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab. 2005; 90(7): 3847–3853.
  7. Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1996; 866: 1–107.
  8. Burger HG, Dudley EC, Cui J, et al. A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab. 2000; 85(8): 2832–2838.
  9. Spencer JB, Klein M, Kumar A, et al. The age-associated decline of androgens in reproductive age and menopausal Black and White women. J Clin Endocrinol Metab. 2007; 92(12): 4730–4733.
  10. Lasley BL, Santoro N, Randolf JF, et al. The relationship of circulating dehydroepiandrosterone, testosterone, and estradiol to stages of the menopausal transition and ethnicity. J Clin Endocrinol Metab. 2002; 87(8): 3760–3767.
  11. Yasui T, Matsui S, Tani A, et al. Androgen in postmenopausal women. J Med Invest. 2012; 59(1-2): 12–27.
  12. Sowers MFR, Zheng H, McConnell D, et al. Testosterone, sex hormone-binding globulin and free androgen index among adult women: chronological and ovarian aging. Hum Reprod. 2009; 24(9): 2276–2285.
  13. Adashi EY. The climacteric ovary as a functional gonadotropin-driven androgen-producing gland. Fertil Steril. 1994; 62(1): 20–27.
  14. Alpañés M, González-Casbas JM, Sánchez J, et al. Management of postmenopausal virilization. J Clin Endocrinol Metab. 2012; 97(8): 2584–2588.
  15. Sluijmer AV, Heineman MJ, De Jong FH, et al. Endocrine activity of the postmenopausal ovary: the effects of pituitary down-regulation and oophorectomy. J Clin Endocrinol Metab. 1995; 80(7): 2163–2167.
  16. Crawford S, Santoro N, Laughlin G, et al. Circulating Dehydroepiandrosterone Sulfate Concentrations during the Menopausal Transition. J Clin Endocrinol Metab. 2009; 94(8): 2945–2951.
  17. Rothman MS, Wierman ME. How should postmenopausal androgen excess be evaluated? Clin Endocrinol (Oxf). 2011; 75(2): 160–164.
  18. Yang Y, Han Y, Wang W, et al. Assessing new terminal body and facial hair growth during pregnancy: toward developing a simplified visual scoring system for hirsutism. Fertil Steril. 2016; 105(2): 494–500.
  19. Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008; 93(4): 1105–1120.
  20. Azziz R. The Evaluation and Management of Hirsutism. Obstetrics & Gynecology. 2003; 101(5, Part 1): 995–1007.
  21. Yildiz BO, Bolour S, Woods K, et al. Visually scoring hirsutism. Hum Reprod Update. 2010; 16(1): 51–64.
  22. Azziz R, Sanchez LA, Knochenhauer ES, et al. Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab. 2004; 89(2): 453–462.
  23. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961; 21: 1440–1447.
  24. Hatch R, Rosenfield RL, Kim MH, et al. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981; 140(7): 815–830.
  25. Ramezani Tehrani F, Minooee S, Azizi F. Validation of a simplified method to assess hirsutism in the Iranian population. Eur J Obstet Gynecol Reprod Biol. 2014; 174: 91–95.
  26. Hassa H, Tanir HM, Yildirim A, et al. The hirsutism scoring system should be population specific. Fertil Steril. 2005; 84(3): 778–780.
  27. Cook H, Brennan K, Azziz R. Reanalyzing the modified Ferriman-Gallwey score: is there a simpler method for assessing the extent of hirsutism? Fertil Steril. 2011; 96(5): 1266–12670.e1.
  28. Perkins AC, Maglione J, Hillebrand GG, et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt). 2012; 21(2): 223–230.
  29. Sobjanek M, Sokołowska-Wojdyło M, Barańska-Rybak W, et al. Reviev paper
    Hormonal factors in aetiology and therapy of acne vulgaris. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2006; 23(6): 266–272.
  30. Ju Q, Tao T, Hu T, et al. Sex hormones and acne. Clin Dermatol. 2017; 35(2): 130–137.
  31. Cibula D, Hill M, Vohradnikova O, et al. The role of androgens in determining acne severity in adult women. Br J Dermatol. 2000; 143(2): 399–404.
  32. Sarfati J, Bachelot A, Coussieu C, et al. Study Group Hyperandrogenism in Postmenopausal Women. Impact of clinical, hormonal, radiological, and immunohistochemical studies on the diagnosis of postmenopausal hyperandrogenism. Eur J Endocrinol. 2011; 165(5): 779–788.
  33. Markopoulos MC, Kassi E, Alexandraki KI, et al. Hyperandrogenism after menopause. Eur J Endocrinol. 2015; 172(2): R79–R91.
  34. Young R. Sex Cord-Stromal, Steroid Cell, and Other Ovarian Tumors with Endocrine, Paraendocrine, and Paraneoplastic Manifestations. Blaustein’s Pathology of the Female Genital Tract. 2011: 785–846.
  35. Kurman RJ, Carcangiu ML, Herrington CS. World Health Organisation Classification of Tumours of the Female Reproductive Organs: International Agency for Research on Cancer. 2014.
  36. Markopoulos MC, Rizos D, Valsamakis G, et al. Hyperandrogenism in women with polycystic ovary syndrome persists after menopause. J Clin Endocrinol Metab. 2011; 96(3): 623–631.
  37. Diamanti-Kandarakis E, Bergiele A. The influence of obesity on hyperandrogenism and infertility in the female. Obes Rev. 2001; 2(4): 231–238.
  38. Kaltsas GA, Mukherjee JJ, Jenkins PJ, et al. Menstrual irregularity in women with acromegaly. J Clin Endocrinol Metab. 1999; 84(8): 2731–2735.
  39. Kaltsas GA, Korbonits M, Isidori AM, et al. How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome? Clin Endocrinol (Oxf). 2000; 53(4): 493–500.
  40. Kaltsas GA, Androulakis II, Tziveriotis K, et al. Polycystic ovaries and the polycystic ovary syndrome phenotype in women with active acromegaly. Clin Endocrinol (Oxf). 2007; 67(6): 917–922.
  41. Derksen J, Nagesser SK, Meinders AE, et al. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med. 1994; 331(15): 968–973.
  42. Azziz R, Carmina E, Dewailly D, et al. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009; 91(2): 456–488.
  43. Marcondes JAM, Curi DDG, Matsuzaki CN, et al. Ovarian hyperthecosis in the context of an adrenal incidentaloma in a postmenopausal woman. Arq Bras Endocrinol Metabol. 2008; 52(7): 1184–1188.
  44. Kaltsas GA, Mukherjee JJ, Kola B, et al. Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women? Clin Endocrinol (Oxf). 2003; 59(1): 34–43.
  45. Cavlan D, Bharwani N, Grossman A. Androgen- and estrogen-secreting adrenal cancers. Semin Oncol. 2010; 37(6): 638–648.
  46. Rodríguez-Gutiérrez R, Bautista-Medina MA, Teniente-Sanchez AE, et al. Pure androgen-secreting adrenal adenoma associated with resistant hypertension. Case Rep Endocrinol. 2013; 2013: 356086.
  47. Werk EE, Sholiton LE, Kalejs L. Testosterone-secreting adrenal adenoma under gonadotropin control. N Engl J Med. 1973; 289(15): 767–770.
  48. Cordera F, Grant C, van Heerden J, et al. Androgen-secreting adrenal tumors. Surgery. 2003; 134(6): 874–80; discussion 880.
  49. Kaltsas GA, Isidori AM, Kola BP, et al. The value of the low-dose dexamethasone suppression test in the differential diagnosis of hyperandrogenism in women. J Clin Endocrinol Metab. 2003; 88(6): 2634–2643.
  50. Goodman NF, Bledsoe MB, Cobin RH, et al. American Association of Clinical Endocrinologists Hyperandrogenic Disorders Task Force. American Association of Clinical Endocrinologists medical guidelines for the clinical practice for the diagnosis and treatment of hyperandrogenic disorders. Endocr Pract. 2001; 7(2): 120–134.
  51. Re T, Barbetta L, Dall'Asta C, et al. Comparison between buserelin and dexamethasone testing in the assessment of hirsutism. J Endocrinol Invest. 2002; 25(1): 84–90.
  52. Rosenfield RL, Mortensen M, Wroblewski K, et al. Determination of the source of androgen excess in functionally atypical polycystic ovary syndrome by a short dexamethasone androgen-suppression test and a low-dose ACTH test. Hum Reprod. 2011; 26(11): 3138–3146.
  53. van Loenen ACD, Huirne JAF, Schats R, et al. GnRH agonists, antagonists, and assisted conception. Semin Reprod Med. 2002; 20(4): 349–364.
  54. Pascale MM, Pugeat M, Roberts M, et al. Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing tumours. Clin Endocrinol (Oxf). 1994; 41(5): 571–576.
  55. Vollaard ES, van Beek AP, Verburg FAJ, et al. Gonadotropin-releasing hormone agonist treatment in postmenopausal women with hyperandrogenism of ovarian origin. J Clin Endocrinol Metab. 2011; 96(5): 1197–1201.
  56. Di Bisceglie C, Brocato L, Tagliabue M, et al. Acute goserelin administration inhibits gonadotropin and androgen secretion in post-menopausal women with ovarian hyperandrogenism. J Endocrinol Invest. 2003; 26(3): 206–210.
  57. Gueorguiev M, Grossman AB. GnRH analogue use in postmenopausal hyperandrogenism: long-term remission. Endocrine. 2012; 41(2): 342–343.
  58. Picón MJ, Lara JI, Sarasa JL, et al. Use of a long-acting gonadotrophin-releasing hormone analogue in a postmenopausal woman with hyperandrogenism due to a hilus cell tumour. Eur J Endocrinol. 2000; 142(6): 619.
  59. Manieri C, Di Bisceglie C, Fornengo R, et al. Postmenopausal virilization in a woman with gonadotropin dependent ovarian hyperthecosis. J Endocrinol Invest. 1998; 21(2): 128–132.
  60. Legro RS, Arslanian SA, Ehrmann DA, et al. Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013; 98(12): 4565–4592.
  61. Katznelson L, Laws ER, Melmed S, et al. Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99(11): 3933–3951.
  62. Speiser PW, Azziz R, Baskin LS, et al. A Summary of the Endocrine Society Clinical Practice Guidelines on Congenital Adrenal Hyperplasia due to Steroid 21-Hydroxylase Deficiency. Int J Pediatr Endocrinol. 2010; 2010: 494173.
  63. Nieman LK, Biller BMK, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93(5): 1526–1540.
  64. Melmed S, Casanueva FF, Hoffman AR, et al. Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(2): 273–288.
  65. Bolanowski M, Ruchała M, Zgliczyński W, et al. Acromegaly--a novel view of the patient. Polish proposals for diagnostic and therapeutic procedures in the light of recent reports. Endokrynol Pol. 2014; 65(4): 326–331.
  66. Ambroziak U, Bednarczuk T, Ginalska-Malinowska M, et al. [Congenital adrenal hyperplasia due to 21-hydroxylase deficiency--management in adults]. Endokrynol Pol. 2010; 61 Suppl 1(1): 7–21.
  67. Sahdev A, Reznek RH. The indeterminate adrenal mass in patients with cancer. Cancer Imaging. 2007; 7 Spec No A: S100–S109.
  68. Bednarczuk T, Bolanowski M, Sworczak K, et al. Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology. Endokrynol Pol. 2016; 67(2): 234–258.
  69. Ilias I, Sahdev A, Reznek RH, et al. The optimal imaging of adrenal tumours: a comparison of different methods. Endocr Relat Cancer. 2007; 14(3): 587–599.
  70. Fleischer AC, McKee MS, Gordon AN, et al. Transvaginal sonography of postmenopausal ovaries with pathologic correlation. J Ultrasound Med. 1990; 9(11): 637–644.
  71. Wang PH, Chao HT, Liu RS, et al. Diagnosis and localization of testosterone-producing ovarian tumors: imaging or biochemical evaluation. Gynecol Oncol. 2001; 83(3): 596–598.
  72. Siekierska-Hellmann M, Sworczak K, Babińska A, et al. Ovarian thecoma with androgenic manifestations in a postmenopausal woman. Gynecol Endocrinol. 2006; 22(7): 405–408.
  73. Jung SIl. Ultrasonography of ovarian masses using a pattern recognition approach. Ultrasonography. 2015; 34(3): 173–182.
  74. Choi JiIn, Park SB, Han BH, et al. Imaging features of complex solid and multicystic ovarian lesions: proposed algorithm for differential diagnosis. Clin Imaging. 2016; 40(1): 46–56.
  75. Tavassoli FA, Devilee P. Pathology and genetics of tumours of the breast and female genital organs: Iarc. 2003.
  76. Jung SE, Rha SE, Lee JM, et al. CT and MRI findings of sex cord-stromal tumor of the ovary. AJR Am J Roentgenol. 2005; 185(1): 207–215.
  77. Shanbhogue AK, Shanbhogue DK, Prasad SR, et al. Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics. 2010; 30(4): 903–919.
  78. Tanaka YO, Saida TS, Minami R, et al. MR findings of ovarian tumors with hormonal activity, with emphasis on tumors other than sex cord-stromal tumors. Eur J Radiol. 2007; 62(3): 317–327.
  79. Berruti A, Baudin E, Gelderblom H, et al. ESMO Guidelines Working Group. Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23 Suppl 7: vii131–vii138.
  80. Else T, Kim AC, Sabolch A, et al. Adrenocortical carcinoma. Endocr Rev. 2014; 35(2): 282–326.
  81. Libé R. Adrenocortical carcinoma (ACC): diagnosis, prognosis, and treatment. Front Cell Dev Biol. 2015; 3: 45.
  82. Szyszka P, Grossman AB, Diaz-Cano S, et al. Molecular pathways of human adrenocortical carcinoma - translating cell signalling knowledge into diagnostic and treatment options. Endokrynol Pol. 2016; 67(4): 427–450.
  83. Bińkowska M, Dębski R, Paszkowski T, et al. Guidelines for menopausal hormone therapy: Recommendations of the Polish Menopause and Andropause Society - state of knowledge as of December 2013. Prz Menopauzalny. 2014; 13(1): 1–12.
  84. Nieman LK, Biller BMK, Findling JW, et al. Endocrine Society. Treatment of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015; 100(8): 2807–2831.
  85. Navarro G, Allard C, Xu W, et al. The role of androgens in metabolism, obesity, and diabetes in males and females. Obesity (Silver Spring). 2015; 23(4): 713–719.
  86. Lambrinoudaki I. Cardiovascular risk in postmenopausal women with the polycystic ovary syndrome. Maturitas. 2011; 68(1): 13–16.
  87. Polotsky AJ, Allshouse AA, Crawford SL, et al. Hyperandrogenic oligomenorrhea and metabolic risks across menopausal transition. J Clin Endocrinol Metab. 2014; 99(6): 2120–2127.
  88. Schmidt J, Landin-Wilhelmsen K, Brännström M, et al. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab. 2011; 96(12): 3794–3803.
  89. Pelusi C, Forlani G, Zanotti L, et al. No metabolic impact of surgical normalization of hyperandrogenism in postmenopausal women with ovarian androgen-secreting tumours. Clin Endocrinol (Oxf). 2013; 78(4): 533–538.
  90. Kamal A, Tempest N, Parkes C, et al. Hormones and endometrial carcinogenesis. Horm Mol Biol Clin Investig. 2016; 25(2): 129–148.
  91. Gibson DA, Simitsidellis I, Collins F, et al. Evidence of androgen action in endometrial and ovarian cancers. Endocr Relat Cancer. 2014; 21(4): T203–T218.
  92. Allen NE, Key TJ, Dossus L, et al. Endogenous sex hormones and endometrial cancer risk in women in the European Prospective Investigation into Cancer and Nutrition (EPIC). Endocr Relat Cancer. 2008; 15(2): 485–497.
  93. Clendenen TV, Hertzmark K, Koenig KL, et al. Premenopausal Circulating Androgens and Risk of Endometrial Cancer: results of a Prospective Study. Horm Cancer. 2016; 7(3): 178–187.

Regulamin

Ważne: serwis https://journals.viamedica.pl/ wykorzystuje pliki cookies. Więcej >>

Używamy informacji zapisanych za pomocą plików cookies m.in. w celach statystycznych, dostosowania serwisu do potrzeb użytkownika (np. język interfejsu) i do obsługi logowania użytkowników. W ustawieniach przeglądarki internetowej można zmienić opcje dotyczące cookies. Korzystanie z serwisu bez zmiany ustawień dotyczących cookies oznacza, że będą one zapisane w pamięci komputera. Więcej informacji można znaleźć w naszej Polityce prywatności.

Czym są i do czego służą pliki cookie możesz dowiedzieć się na stronie wszystkoociasteczkach.pl.

Czasopismo Forum Medycyny Rodzinnej dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą czasopisma jest VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl