Idiopathic hyperandrode. Tool diagnostics of hyperandrode

Hirerandrogenation is caused by the secretion of male sex hormones in the body of a woman. Androgens are produced by the ovaries and the bark of the adrenal glands. Depending on the primary cause of pathology, clinical symptoms may differ.

Gyperandrogenation in women causes strengthened secretion in the pituitary gland, which blocks the release of the follicularity fluid hormone and estradiol. As a result, the process of ripening of the follicle is disturbed, the egg generation (anosulation) does not exit. The high level of androgen contributes to the formation of multiple cysts in the ovaries (polycystic ovarian syndrome).

Men's hormones reduce the susceptibility of peripheral tissues to, this leads to an increase in blood glucose levels, violation of tolerance to glucose, carbohydrate metabolism and the development of type 2 diabetes mellitus.

Classify true and idiopathic hyperandrode. In the first case in the blood of the woman, the level of androgens is increased, and the sensitivity of peripheral fabric receptors to male hormones is increased in the second.

Causes of pathology

What is hyperandrode and why does she arise? The main causes of the disease are:

• tumors, adrenal metastasis;
• violation of hypothalamic-pituitary regulation, caused by injuries, tumors, inflammatory brain diseases;
• ovarian tumors: Luther, tech;
• androgenital syndrome is a congenital pathology of the adrenal cortex, at which the reinforced method of testosterone occurs.

In women, the causes of hyperandrode cause a violation of hormonal balance, operation reproductive system, metabolic processes in the body.

Symptoms of ovarian hyperandrode

The disease is the ovarian and adrenal genesis - depending on the organ, which begins to produce androgens hardly. The ovarian hyperandrode in most cases is developing against the background of polycystic ovary syndrome, the pathology is raised by hormoneproproduction tumors.

SPKY is characterized by a disruption of the menstrual cycle, infertility, an increase in the level of androgens in the blood. The figure of the girl varies on the male type, the hair on the face and body begin to grow, the volume of the waist, chest increases, the fat layer is deposited at the bottom of the abdomen. The work of the sebaceous glands is disturbed, seborrhea appears, angry rash, which is not amenable to treatment. On the skin of the thighs, buttocks appear stretch marks. Night apnea (Breathing delay) leads to insomnia.

In the photo, a woman with characteristic signs of hirsutism.

Characteristic symptoms of hyperandrogenation with PCOS - this appearance premenstrual syndrome. Women are becoming irritable, they often change the mood, worried migraine, intense pain at the bottom of the abdomen, swelling, diseases of the mammary glands.

The ovaries are 2-3 times increasing in size, their capsule is thickened. Inside the organ, multiple cystic education is found. Hormonal imbalance causes thickening and hyperplasia of the endometrium of the uterus, monthly becomes more prolonged, abundant, with the release of blood clots.

Symptoms of adrenal hyperandrode

This type of virilization is developing against the background of androgenital syndrome. it healthy diseasewhich causes the strengthened secretion of androgen in the adrenal cortex. The congenital deficit of the organ enzymes to a certain point is compensated by the body, but when exposed to a number of factors, a violation of a hormonal balance occurs. Provoke such a state can pregnancy, strong stress, the beginning of sexual life.

The reason for hyperandrode adrenal type can be hormone-producing tumors. Cancer cells of the mesh zone of the cortex layer produce "weak" androgens. In the process of metabolism, men's hormones turn into a more active shape and change the common hormonal background of women. contributes to the acceleration of these processes.

The adrenal hyperandrode causes cyclic disorders in the ovaries by increasing the level of estrogen, the growth and ripening of the follicle occurs, the menstrual cycle is disturbed, monthly ceases can be discontinued. The process of ovulation does not occur, a woman cannot get pregnant and endure a child.

Symptoms of hyperandrode adrenal genesis in girls:

• the deformation of the external genital organs at birth, the child is difficult to determine the floor (women's hermaphroditism);
• delay in sexual development, menarche begin in 15-16 years, the menstrual cycle is irregular, accompanied by abundant blood loss;
• in girls in adolescence, there are signs of girsutism: the hair on face and body grow like men;
• acne rash, seborrhea, skin pigmentation;
• partial atrophy of the mammary glands;
• increase the size of the clitoris;
• alopecia - hair loss on the head;
• figure changes: narrow thighs, wide shoulders, low growth;
• rough voice.

In women of reproductive age, adrenal hyperandrode leads to the interruption of pregnancy in early terms. This is caused by the cessation of the growth of the uterus due to the formation of an infallible yellow body. Most girls are completely disturbed by menstrual and childbearing function, it develops in infertility, the sexual attraction increases. Girsutism is expressed weakly, the physique does not change, metabolic processes are not violated.

Mixed type of hyperandrode

Hyperandrogenation of mixed genesis is manifested by the symptoms of the ovarian and adrenal form of the disease. Women detected polycystic ovaries and signs of androgenital syndrome.

Manifestations of a mixed type of disease:

• acne;
• strya;
• increased blood pressure;
• violation of the menstrual cycle;
• cysts in the ovaries;
• infertility, interruption of pregnancy in the early stages;
• violation of glucose tolerance or high level blood sugar;
• increased content of low density lipoproteins.

Hyperandrode can cause systemic diseaseswho amazed the bark of adrenal glands, ovaries or brain, violate metabolism. This, nervous anorexia, schizophrenia, type 2 diabetes, acromegaly, prolactinoma.

Peripheral and Central Hyperagon

With the defeat of Central nervous systeminflammatory infectious diseases Or the inxication of the body can be suppressed by the secretion of gonadotropic pituitary hormones, which are responsible for the production of luteinizing and follicle-sustamulating hormone. As a result, the process of ripening the follicle in the ovary and the synthesis of genital hormones is disturbed, and the production of androgen increases.

Women discover symptoms, ovarian dysfunction, menstrual disorders, skin rashes, PMS.

Peripheral hyperandrode caused by an increase in the activity of the enzyme of the skin, the sebaceous glands of 5-α-reductase, which converts testosterone into a more active androgen. This leads to varying severity, the appearance of vulgar acne.

Hyperandrogenation during pregnancy

Pregnant women have an increase in androgen levels is the cause of spontaneous abortion. The most dangerous time is the first 7-8 and 28-30 weeks. In 40% of patients, intrauterine hypoxia of the fetus is observed, most often this happens in the third trimester. Another complication is the late toxicosis, while the work of the kidneys deteriorates, the blood pressure increases, the body edema appears.

Hyperandrogenation during pregnancy can lead to premature disintegration of accumulating waters, complicated childbirth. Changing the hormonal background negatively affects the development of the child, the babies can break brain circulation, there are signs of intrauterine hypotrophy.

Gyperandrogenation and pregnancy are the causes of urgent hormone therapy To prevent abortion and other complications. Women who have previously happened miscarriage, unbearable fruit, raising the level of men's hormones, it is necessary to conduct a thorough examination at the pregnancy planning stage.

Diagnosis of the disease

The diagnosis - hyperandrogenation is established according to the results of laboratory studies on the level of hormones. With the syndrome of polycystic ovary in the blood of the woman, the level of testosterone, luteinizing hormone increases. The concentration of FSH, in the blood and 17-CC in the urine is stored within the normal range. The LG / FSH ratio is increased 3-4 times. With hormone-dependent tumors of ovarian in the blood, the level of testosterone and prolactin is significantly increased.

The mixed form of the disease is characterized minor increase Testosterone level, LH, DHAA-C in the blood and 17-ks in the urine. The concentration of prolactin is normal, and the FSH is reduced. The ratio of LH / FSH - 3.2.

To determine the primary cause, hyperandrogenment is carried out with dexamethasone and. Positive result The test with xg confirms the polycystic lesion of the ovaries, which causes a hormonal imbalance. The negative response indicates the adrenal nature of hyperandrogenation.

The Abraham test allows you to identify the disease of the adrenal genesis, with the introduction of synthetic glucocorticoids, the synthesis is suppressed in the front proportion of the pituitary gland, which ceases to stimulate the adrenal cortex. If the result is positive, it is an adrenal hyperandrode, a negative answer may be a sign of a tumor of the cortical substance.

Additionally, the ovarian ultrasound is carried out to identify cysts, changes in the size and structure of the body. Electroencephalography, MRI, CT brain is shown in suspected pituitary defeat.

Treatment methods

Therapy is prescribed individually for each patient. Androgen receptor blockers reduce the effects of male hormones on the skin, ovaries (flutamide, spironolactone). Androgen secretion inhibitors are inhibiting testosterone to endocrine glands (ciproterone acetate). These means restore the balance of hormones, eliminate the symptoms of pathology.

Hyperandrogenation of adrenal glands is compensated by glucocorticoids that suppress excess androgen. Women prescribe dexamethasone, prednisone, take them and during pregnancy, if the future mother has increased testosterone. It is especially important to be timely treated to girls who have close relatives with congenital androgenital syndrome. Dosage and duration of medication prescribes a doctor.

Hormonal treatment of hyperandrogenation is carried out with glucocorticosteroids combined with oral contraceptives (Diana-35), GNVG agonists. Such drugs are treated with low-heated hyperandrogenation of ovarian genesis, SPKA.

Non-media treatment

To restore the hormonal balance, women are advised to regularly engage in moderate physical exertion, refuse harmful habits, news healthy image Life. It is important to adhere to the power mode, make a balanced diet, eliminating coffee, alcohol, carbohydrates, animal fats. It is useful to eat fresh fruits, vegetables, fermented dairy products, dietary grade meat and fish. To replenish the deficit of vitamins, pharmacy preparations are taken.

Treatment by folk remedies can be carried out only in the complex with the main therapy. It should be pre-obtaining a doctor's advice.

Hyperandrode causes violations in the work of many and organs and systems, leads to the development of adrenal and ovarian failure, infertility, type 2 diabetes mellitus. In order to prevent the appearance of symptoms of hirsutism, skin rashes, hormone therapy is shown.

Bibliography

1. Kozlova V.I., Pukhner A.F. Viral, chlamydial and mycoplasma diseases of genitals. Guide for doctors. Saint Petersburg 2000.-574 p.
2. Unbearable pregnancy, infection, innate immunity; Makarov O.V., Bakhareva I.V. (Gankovskaya L.V., Gankovskaya O.A., Kovalchuk L.V.) - "Gootar - Media" .- Moscow. - 73 S.-2007.

The attitude of doctors working in state clinicsThe "commercial" colleagues are quite peculiar. The latter are often accused of korestolubia, neglecting the interests of patients, naughty relation to safety and many other "sins". What is the most interesting, not for reason. Take for an example a patient who appealed to the clinic with complaints of the gun under the lips. Warning and attentive eskulap will fight with a patient, will send it to a number of analyzes, after which it recommends have a good specialistwhich is engaged in epilation. Familiar, isn't it?

Meanwhile, our heroine will "forget" report that it is not necessary to treat the problem, but the disease itself. After all, hated hair on the face is often one of the symptoms of hyperandrode, and not a harmless cosmetic defect. We are talking about this today.

Disease or pathology?

Whatever enough, hyperandrode is no one or the other. In fact, this is the result of the operation of the endocrine system, associated with the increased activity of male genital hormones. Consequently, treatment of hyperandrode in the cosmetology salon is no more useful than the analgin tablet during dental pain. The most common causes of hormonal failure are as follows:

• SPKY - polycystic ovarian syndrome (primary and secondary).
• Idiopathic girsutism.
• Virilizing tumors.
• Dysfunction of adrenal cortex.
• Stromal teomatosis of ovarian.

How easy it is to notic, the list is quite extensive. Therefore, let us remind myself once again to readers that when the first symptoms appear (in detail about them, it is necessary to contact a beautician, girlfriends or grandmother-grass, but to a doctor. Of course, if you do not want to use a razor for many years and take part in weightlifting tournaments.

Symptoms and external manifestations of hyperadogenia

• Giroustism. It is important here to understand that the gun already mentioned above the upper lip is the vertex of the iceberg. In general, under the girsutism, the excessive growth of the hair around the nipples, along the central line of the abdomen, the legs, buttocks and the rear surface of the hip.

It is important here to understand that the gun already mentioned above the upper lip is the vertex of iceberg.

• Acne, or acne spindles on the skin. They can appear not only in adolescents, but if the teenagers often pass by themselves, then the most older people require appropriate treatment.

Acne, or acne rashes on the skin are characteristic not only for adolescents, but also for adults

• Alopecia on male type. A woman begins to lose hair on the dark and frontal regions of the head, but retains them on the back of the head and whiskey.

Woman begins to lose hair on dark and frontal head areas

• Obesity for male type. Everyone can gain extra kilograms, but women "prefer" the middle and lower parts of the body, and the men are upper. In the beer with default there is nothing good, especially if it appears in the representatives of the fine floor.

Everyone can gain extra kilograms, but women "prefer" the middle and lower part of the body

• Excessive peeling of the scalp (Seborrhea).

Excessive peeling of the skin of the face can be combined with acne

• Reduced sensitivity to insulin. A much more terrible symptom, which is fraught with the development of diabetes.
• Menstrual cycle failure until complete cessation of menstruation in reproductive age.
• Chronic unbearable when each pregnancy ends with miscarriage or premature births.

Immediate causes of hyperadogenesis

We have already considered the factors that can contribute to the development of hormonal failure, now it makes sense to understand direct reasons hyperadogenia.

• The failure of the hypothalamus or pituitary gland.
• Genetically due to adrenal cortex dysfunction.
• Hormone-producing tumors of ovarian and adrenal glands.
• Neoplasms in pituitary, both good- and malignant (most dangerous tumor - prolactinoma).
• Hereditary predisposition transmitted by the female line.
• Increased level of hormones of adrenal cortex (Incenko-Cushing disease).
• Adrenogenital syndrome.
• Hypertecosis of ovaries.
• Reducing the production of hormones thyroid gland.
• Excessive production enzyme 5-alpha reductase.
• Launched liver diseases.
• The side effect of the long-term admission of some hormone-containing drugs (anabolic steroids, glucocorticoids, hormonal contraceptives).

Takers of conservative treatment

If the doctor has given you a diagnosis of hyperoids, this does not mean that the urgent surgery is necessary. In most cases, the problem can be cope with less radical methods, but this is if the treatment is not allowed on the self-shot. What can the patient offer a doctor?

• Revise your own diet. After all, excess body weight is one of the risk factors. Try to reduce the use of high-calorie products by turning on the hypochalorial diet.

Try to reduce the use of high-calorie products by going to the hypochalorial diet

• Workout. If the prospect of becoming an Olympic champion you do not like, classes physical culture Anyway, you need to devote at least one hour three times a week. It is not bad to purchase a subscription to a visit to the pool or the aerobics section, as well as walking more and less ride in public transport.

Medical therapy

• Estrogen-Gestagenic preparations.
• Medicines whose action is aimed at suppressing the development of male genital hormones androgen.
• Oral contraceptives with a high content of antiandrogen (Androkur, Diana-35 and others).
• Gonadotropin-relazing hormone agonists. They indirectly help reduce the production of estrogen and androgen.
• Progesterone-containing drugs.

Estrogen-Gestagenic preparations are used as therapy

Treatment of concomitant diseases and pathologies

• Polycystic ovarian syndrome and any concomitant gynecological diseases.
• Saving adrenogenital syndromeaimed at the oppression of redundant formation of male genital hormones.
• Liver disease and thyroid gland.

Operational intervention

• Laparoscopic excision of the ovarian capsule.
• Wedge-shaped ovarian resection.
• Demired by the ovarian with the needleter of the phillicular cyst.
• Electrocusing.
• Thermocautionerization.
• Radical removal of a tumor provoking male hormone production.

Recipes of traditional medicine

They can be useful in the complex medical eventsBut should not replace traditional methods of therapy. Consequently, his intention is treated with herbs, you must inform your attending physician and only if he does not mind anything, to start collecting the necessary ingredients.

• Herbal collection number 1. You will need the following herbs: Distribution Dynamon, Salfa and Avdnusha (1 part), Cuffs ordinary and Labacker Vysolisset (2 parts). 1 tbsp. l. The mixture falls asleep into a glass of water, it is maintained in a water bath for 15-20 minutes and focusing. Next, it should be added to the decoction (necessarily hot, and not cooled) 1.5 ml of a 10% tincture of rhodium pink. Reception scheme - 1/3 glasses three times a day before meals.

Necessary components of herbal collection

• Herbal collection number 2. Connect 2 tbsp. l. Marks and one art. l. Yarrow and dyeing. Fill the original raw material 500 ml of boiling water, let's last about an hour and strain. 1 glass of collection is divided into 2 receptions (in the morning immediately after the lifting and immediately before bedtime).

Photographic prepaid

Attention. Treatment during pregnancy strictly after consulting with the attending physician!

• Tincture and infusion of red brush. This grass has been considered one of the most effective in the treatment of a variety of pathologies for the female part. In addition to the fact that it restores the disturbed hormonal background, the red brush contributes to improving immunity and even rejuvenates the body. But in the context of our today's conversation, it should be remembered that this grass has a pronounced antandogen effect. So, for the preparation of tincture, 80-90 g of the initial raw material should be taken and pour it for 1-2 weeks 500 ml of vodka. Take 1/2 h. L. 3 times a day before meals. If you prefer an ordinary infusion, take 1 tbsp. Herbs, pour a glass of boiling water and insist 60-90 minutes. Take 3 times a day before the meal of 1/3 cup.

The red brush of ancient times is considered one of the most effective in the treatment of a variety of pathologies for the female part.

Attention! If you are subject to hypertension, it is better to refrain from treatment with a red brush!

• Salad of young nettle. Connect 100 g of sorverel and green onions, as well as 200 g of chopped nettle leaves. All the ingredients are finely cut, then skip through the meat grinder. Add a mixed mixture boiled eggs (to taste), and make the finished salad to fuel vegetable oil and decorate the Radish slices.
• Nanish nettle. 15-20 g of dry leaves pour 200 ml of water, insisted in closed dishes and strain. Take 1-2 tbsp. l. 3-4 times a day.
• Nasty nettle. Leaves or young shoots are cut and poured with 70% alcohol or vodka in the proportion of 1:10. Hold up at least 10 days in a dark and cool place. Take the usual way: 1/2 teaspoon 3 times a day strictly before meals.

Hyperandrogenation - a pathological condition that occurs in girls and women, and is characterized increased level Androgen in the body. Androgen is considered a male hormone - in women's body It is also present, but in minor quantity, therefore, when its level increases, the woman appears characteristic symptoms, among which the cessation of menstruation and infertility, the masculine type and some others. The change in the hormonal background requires urgent correction, as this may cause the development of many pathologies in the body of a woman.

Androgens are produced by ovaries, adipocytes and adrenal glands. And they affect not only some external manifestations, but also to the work of the internal organs, including the kidneys, liver, the reproductive system, the musculoskeletal system.

Varieties and causes of occurrence

Depending on which organ begins to produce a large number of Androgen, allocate several forms of this pathological state. The most common form is ovarian hyperandrodeIn which excess hormones is produced by ovaries. This is usually due to pathologies such as ovarian polycystosis or organ tumors capable of producing androgens.

Most often, such a form of pathology is hereditary in nature - if the increase in the development of androgens was observed in the mother, then the likelihood is highly like that the diseases appear and its offspring. Accumulating, androgens and cause the development of such a pathological condition as hyperandrode. Also, the reasons for the development of this form of hyperandrode can be held in violations of the hypothalamus and pituitary glands responsible for the normal hormonal background of the female organism.

Second form - adrenal hyperandrodewhich can meet girls already in early age. The reasons for the development of this form are the insufficiency of enzymes that ensure the products of adrenal hormones.

The central form of pathology develops in cases where the pituitary gland or hypothalamus is affected by a tumor. But there is also a peripheral form that occurs as a consequence of diabetes and with violations of fat metabolism.

Most common is mixed hyperandrodewhich is due to several violations at once. It can be adrenal hyperandrode and disruption of ovarian genesis or ovarian and central genesis, etc.

Hyperandrogenation and pregnancy

As mentioned above, hyperandrode can cause girls and. But there are such exceptional cases when a woman with such pathology can still become pregnant, and then it should be prepared for the fact that hyperandrode during pregnancy is mainly ends with involuntary miscarriage. In those cases, if the miscarriage did not occur, the likelihood of fetal fetal is high in the womb with the need to mechanically clean the uterine cavity for its evacuation.

All this adversely affects the health of the woman and further aggravates the problem of hormonal imbalance, so that this does not happen, the diagnosis of hyperandrode should be carried out before conception, in order to follow, after treatment, the woman had a chance to become a mothers of a beautiful baby.

Of course, not in all cases of hyperandrode and normal pregnancy are incompatible concepts - if hormonal violations developed on late time, there is a risk of premature birth, but the baby will be healthy. Therefore, it is very important to start in a female consultation in a timely manner - the doctor can not only determine the pathology in the early terms, but also to successfully treat it, giving a woman the opportunity to endure a child.

Symptoms

As mentioned above, the syndrome of hyperandrode in girls can be determined in a small age. These are such symptoms of violation of the hormonal background, as:

• clitoris hypertrophy;
• partial battle of large germ lips;
• increased sketching on male type (median band of belly, chin and cheeks, chest.).

In girls who suffer from this disease in adolescence, menstruation does not begin, and if the disease occurs in women, the menstrual cycle occurs. Other symptoms of such pathology as hyperandrode is:

• hair loss on the head;
• the appearance of skin rashes on the face and body (by type acne);
• pronounced dryness skin Pokrov, peeling.

Also in girls and women are celebrated metabolic disordersexhibited most often different Stages, as well as muscle atrophy. In some cases, a female voice can freeze and become similar to male - most often such a symptom manifests itself in adult women. If women's hyperandrode develops in young age, The likelihood is high that their muscle corset will increase, which is why the body will acquire a courageous relief and a large muscular array.

Of course, there are general symptoms pathological condition in women. These include:

• irritability;
• fatigue;
• susceptibility to infections due to the decrease in immunity, etc.

Diagnosis and treatment

To diagnose, based only on the external manifestations of pathology, it is impossible. Therefore, the doctor appoints to patients laboratory studyallowing to appreciate the hormonal background, including the level of androgens. It is also shown to conduct an ultrasound research, which will give a specialist the opportunity to identify the causes of the disease, without which effective treatment is impossible.

Treatment depends on the form of pathology discovered by a woman. In particular, if it has hyperandrode of the ovarian genesis, shows the reception of antandrogenic oral contraceptives. And to utilize excess hormones, the use of such medicineslike methiprette and dexamethasone. These funds increase the level female hormonesAnd those, in turn, utilize the surplus of men.

When the cause of the development of pathology becomes a tumor, its operational removal is required with the subsequent treatment, which will be selected for the patient individually in each case.

If the girls or women are diagnosed with adrenal hyperandrode, then its treatment will be to apply glucocorticoid hormones - the one of the above decxamethasone. Note that the easiest to treat the disease of the ovarian genesis, since the modern pharmaceutical industry offers a large amount of means that can stabilize the hormonal background of women. The adrenal hyperandrode and a mixed form of pathology is more difficult to treat, and representatives of beautiful sex are required for a long time (and even life) to use drugs prescribed by the doctor.

Treat disease folk methods It is possible, but their effectiveness is very low. Nevertheless, there are some herbs with a hormone-stabilizing effect, so if they are drunk in the form of infusions and decoctions, they can improve the state of the woman slightly. True, it is possible to treat pathology in this way only after consulting with a specialist.

Is everything correctly in the article from a medical point of view?

Answer only if you have confirmed medical knowledge

Diseases with similar symptoms:

Avitaminosis is the painful state of the person who comes as a result of an acute shortage of vitamins in the human body. Distinguish the spring and winter avitaminosis. Restrictions, as for the floor and the age group, in this case there is no.

Incenko-Cushing syndrome - the pathological process, on the formation of which affects high rates Glucocorticoid hormone levels. The main one is cortisol. Therapy of the disease should be complex and aimed at relieving the causes that promotes the development of alend.

"Mature discharge (monthly) have many women, but not all. They are in Flookoks with female appearance, but not those who are tremecated and the likeness ... "
Aristotle, 384 -322 BC. e.

Hyperandrode syndrome is a rather extensive group endocrine diseasesthat occur by virtue of very diverse pathogenetic mechanisms, but combine the principle of similar clinical symptomatics Due to excessive amounts and / or quality (activity) of men's sex hormones in the female body. The most widespread the following hyperagrane states.

• Polycystic ovarian syndrome (SPKI):
  a) primary (Stein-Levental syndrome);
  b) secondary (within the framework of the neuroendocrine shape of the so-called hypothalamic syndrome, with hyperprolactinemia syndrome, against the background of primary hypothyroidism).
• Idiopathic girsutism.
• Congenital dysfunction of adrenal cortex.
• Stromal teomatosis of ovarian.
• Virilizing tumors.
• Other more rare options.

In most cases, the causes of the formation of these diseases are studied quite in detail, and there are specific effective methods their corrections. Nevertheless, the interest of scientists and clinicians of various specialties to the problem of hyperandrode does not dry up. Moreover, the object of the undercessant and most close attention, especially over the past decade, serves the SPKA, called the otherwise syndrome of hyperandogenic dysfunction of polycystic ovaries, sclerokystosis of the ovaries, stem-leventula syndrome. So close interest in this problem is justified.

First, only in the 90s. The twentieth century managed to obtain irrefutable evidence that the SPKA represents not only the most common hyperaldogenic state (about 70-80% of cases), but also one of the most common diseases of the endocrine sphere in girls and women of childbearing age. Judging by numerous publications recent yearsThe extremely high level of SPKA frequency is impressive, which ranges from 4 to 7% in the population. Thus, approximately every 20th woman at various stages of his life - from infancy to old age - consistently faces various manifestations of this pathology, and from not only the reproductive sphere, but also many other functional systems and organs.

Secondly, the last decade is marked by a number of events and discoveries that served as the key to a new understanding of many questions of PTKA pathogenesis. This, in turn, became a powerful impetus to the rapid development of very original, effective and promising methods not only the treatment and rehabilitation of the already formed pathology, but also of its remote hormonal metabolic consequences, and was also the basis for attempting to create a preventive action program aimed at Preventing the development of the disease and its numerous somatic complications.

Therefore, in this article, a special emphasis is made primarily on the problems of diagnosis and achievements in the therapy of the PCA.

Etiopathogenesis

Relatively recently - at the end of the last century - the newest scientific concept was proposed and thoroughly argued that two interrelated components participate in the pathogenesis:

• the increased activity of cytochrome p-450c17alph, which determines the excessive products of androgen in the ovaries / adrenal glands;
• hyperinsulinemic insulin resistance leading to multiple defects in the regulation of carbohydrate, fatty, purine and other types of metabolism.

These two components are associated in the same patient in an increasing way, but quite a law - but - through a single primary mechanism. A variety of sufficiently convincing information about the existence of a single universal congenital enzyme anomaly is obtained, which determines excessive phosphorylation of the serine (instead of tyrosine), both in steridogenic enzymes (17β-hydroxylase and C17,20-Liaz) and in the substrates of the Insulin receptor β-subunit (IRS-1 and IRS-2). But at the same time, the final effects of such a pathological phenomenon differ: the activity of steroid enzymes, on average, doubles, which entails hyperandrode, while the sensitivity to insulin on the post-receptor level in the peripheral tissues is almost doubled, which is adversely affected by the state of metabolism as a whole. Moreover, reactive hyperinsulinism, compensatory emerging in response to the pathological resistance of target cells to insulin, contributes to additional excessive activation of the androgen-synthesizing cells of the ovarian-adrenal complex, i.e., even more potentials of the woman's androenization of the body, starting with children's age.

Clinical characteristic

From the point of view of the classical CTC terminology, it is characterized by two bonded signs: a) chronic annovulatory dysfunction of ovarian, determining the formation primary infertion; b) symptom complex hyperandrode, which has distinct clinical (most often) and / or hormonal manifestations.

Along with this, the newest model of Pathogenesis of SPKA made it possible to significantly clarify and expand the ideas about the "complete clinical portrait" of the disease. The palette of his symptoms, along with the IF Stein and ML LEVENTHAL described by Chicagish gynecologists, almost 70 years ago (1935) by classical signs of hyperandrode, taking into account the latest representations in most patients includes various (dis) metabolic disorders due to hyperinsulinism, which were already identified for the first time 20 years ago, thanks to the pioneer works of researchers GA Burghen et al. (Memphis, 1980). Because of the abundance of such principles in the state of health of a woman with a PCA, a clinical picture of this combined pathology (hyperandrogenation along with hyperinsulinism) received a very figurative and clear reflection not only in the statements of an ancient Greek philosopher (see the epigraph), but also in the articles of modern authors.

Symptoms of pathological androenization

The hyperandrode clinic consists of a few symptoms (only about ten signs), but, depending on the severity of the process, the overall appearance of patients can vary significantly. And with PCOS, which formed at the expense of relatively low hyperproduction, preferably not the most aggressive androgens, draws attention to the semiotics of only hyperandogenic dermatics - without virilization. This fundamentally distinguishes it from cases of extremely severe androgenation in virilizing egg tumors and adrenal glands having a completely different nosological origin.

Girsutism- This is not only a sign of SPKA, the most bright and "catchy" when it comes to medical diagnosis, but also a factor, most traumatic psyche patient. Ferrimean-Gullewe's scale allows for a minute to rate the severity of girsutism in points. This technique has been used for over 40 years and has won in world practice universal recognition. On the scale, the indicator of the so-called hormonal number is easily calculated (four-point estimate in nine androgen-dependent zones). It reflects the androgenous saturation of the patient, as a rule, much more accurate than the testosterone concentration indicator in the blood serum, which is available in domestic laboratory practice for measurement only in total quantity - as a common testosterone. It is well known that the latter, even with pronounced pathology, can remain within the limits of the reference norm (by reducing the level of biologically inactive hormone fraction associated with TESG transport protein), while the result of visual screening diagnostics on the hormonal number of Ferrimean-Gullewe will deserves more trust Since the direct correlation of the magnitude of this marker with the concentration of free androgen was repeatedly shown. It is the free Testosterone fraction that determines the severity of the process, so in practice the hormonal score of the estimation of hirsutism can be considered as a reliable "mirror" of hyperandrode. In our own work, we have long been using the original gradation of the severity of girsutism on a hormonal number: I degree - 4-14 points, II - 15-25 points, III - 26-36 points. Experience shows that the doctor's percanicity should be extremely high in any case - even in the absence of virile signs - especially if a woman addresses a doctor with a long-time Hisutism of the III degree, as well as at the II degree of gravity of the disease, quickly formed due to the "galloping" flow rapidly Diseases.

Androgenic alopecia - Reliable diagnostic marker of virile variants of SGA. Like other types of endocrine baldness, it is diffuse, not focal (nest) character. But in contrast to the baldness with other diseases of the glands of the internal secretion (primary hypothyroidism, polyglandular deficiency, panhibitionitutuitarism, etc.), androgenic alopecia is inherent in a certain dynamics. As a rule, it manifests the loss of hair in the temporal areas (BIMPMEROUS ALOPECTION with the formation of the symptoms of "temporal suggestions" or "the guise of a secret advisor" and "widow peak"), and then applies to the parietal region (parietal alopecia, "baldness"). The features of the synthesis and exchange of androgens in the perimenopausal period are explained by the fact that up to 13% of women at this age have "peak" or more pronounced forms of baldness in the absence of other signs of SGA. On the other hand, the baldness as a formidable indicator of the heavy flow of the SGA is more often observed and formed faster (sometimes ahead of the girsutism) in this age groupthat requires the exclusion of the androgenproduction tumor.

Symptoms of insulin resistance and hyperinsulinism

• Classical manifestations of pathology of carbohydrate metabolism (broken tolerance to glucose or type 2 diabetes mellitus). With a BC, a combination of hyperandrode and insulin resistance, called R. Barbieri et al. In 1988, Hair syndrome (Hyperandrogenism and Insulin Resistance) occurs most often. Even among adolescents with the emerging SPKA, insulin resistance is detected by a standard glucose-olerant test with 75 g of glucose in about a third of cases (mainly by NTG type), and at an older age - more than half of the patients (55-65%), and by 45 years, the frequency Diabetes can be 7-10% against 0.5-1.5% in the peer population. It should be noted that recently, according to the results of six prospective studies, it is in patients with SECCs and NTGs, first identified at a young age, the "acceleration" of diabetes is clearly proven. Especially often, intolerance for carbohydrates progresses in the direction of obvious pathology in those who achieve the extreme degree of obesity and has a family history burdened by diabetes (D.A. Ehrmannet Al., 1999).
• Comparatively rarely (only in 5%) The hair combination is complemented by the third element - the most typical clinical stigma of insulin resistance in the form of Acanthosis Nigricans and is indicated as HAIR-AN syndrome. Black Acantosis (Acanthosis Nigricans) is a papillary-pigment skin dystrophy, manifested by hyperkeratosis and hyperpigmentation (mainly on the neck, in the axillary and inguinal regions). This feature is especially pronounced against the background of extreme degrees of obesity, and, on the contrary,, as weight loss and sensitivity correction, the intensity of the Akutsis is weakening.
• Massive obesity and / or redistribution of subcutaneous fatty tissue on android type (an abdominal type of "apple"): the body mass index is more than 25 kg / mi, the waist circle is more than 87.5 cm, and its attitude to the circumference of the hips is more than 0.8.
• The presence in an apparentite history of an isolated Pubarch is the first sign of the debut of androgenation in the form of sexual sipop, before the start of the estrogenization of the chest glands, especially in combination with a body weight deficit at birth.

Laboratory and instrumental diagnostics

Like paradoxically, but despite the enormous breakthrough of theoretical medicine in the understanding of the molecular biological and genetic mechanisms for the development of the SEC, in the world, there is still not a coordinated decision on the criteria for the diagnosis of SPCs, and the only document, at least partly regulating the survey process and designed to prevent hyperdiagnosis of the disease rather than to ensure its identification on early stagesare the recommendations of the US National Health Institute adopted at the conference in 1990

According to this document, which is also guided by the absolute majority of researchers dealing with this problem, the diagnosis of SPCs is a diagnosis of exception. To verify it, in addition to the presence of two clinical criteria for the inclusion, which was discussed above (anointing + hyperandrogenation), also needed the third - the absence of other endocrine diseases (congenital dysfunction of the adrenal cortex, virilizing tumors, diseases of Izeno-Cushing, primary hyperprolactinemia, thyroid pathology ). Fully separating such a point of view, we for the past 15 years each patient consider it necessary to complete the diagnosis of the SPK additional examinations. This is extremely important not only and not so much to confirm the diagnosis, as for further use as criteria when choosing differentiated therapy on an individual basis. We are talking about the following studies.

1. On the seventh-tenth day of the menstrual cycle - "Gonadotropic index" (LG / FSH) \u003e\u003e 2, the OST is normal or is incompletely elevated (approximately in 20% of cases).

2. At the seventh-tenth day of the menstrual cycle, characteristic signs are detected on the ultrasound:

• a bilateral increase in the volume of both ovaries (according to our data, more than 6 ml / m² of the body surface area, i.e., taking into account the individual parameters of physical development for the growth and mass of the body at the time of the ultrasound of the small pelvis);
• ovarian fabric "Polycystic" type, i.e., on both are visualized by 10 and smaller immature follicles with a diameter of up to 8 mm, as well as an increase in the area of \u200b\u200bhyperheogenic stroma magazine both ovaries;
• ovarian-uterine index (average ovarian volume / uterine thickness)\u003e 3.5;
• thickening (sclerosis) capsules of both ovaries.

3. Laboratory signs of insulin resistance:

• increased basal level (on-line) insulin level in blood serum or increasing the calculated glucose-insulin index Homair.

However, in April 2003, the experts of the American Association of Clinical Endocrinologists developed a new document, according to which it was decided to rename the complex of clinical and biochemical disorders, known since 1988 as (dis) metabolic syndrome X, in insulin resistance syndrome. And when it is verified it is proposed to navigate not to hormonal indicators, but on the surrogate biochemical parameters.

Identification of insulin resistance syndrome

• Triglycerides\u003e 150 mg / dl (1.74 mmol / l).
• High density lipoprotein cholesterol in women< 50 мг/дл (1,3 ммоль/л).
• Arterial pressure\u003e 130/85 mm Hg. Art.
• Glycemia: an empty stomach 110-125 mg / dl (6.1-6.9 mmol / l); 120 min after loading with glucose 140-200 mg / dL (7.8-11.1 mmol / l).

Completing the conversation about the Technology of the Diagnostics of the PCT in modern clinical practice, especially emphasize that each of the named symptoms in the separation from other independent diagnostic significance has no. At the same time, the greater the same patient with hyperandogenic dysfunction of the ovarian paraclinic signs from the above list, the more substantiated, justified, effective and safe will be an attempt to endocrinologist / gynecologist to apply new technologies and modern protocols for differentiated treatment.

Treatment

The individual tactics of conducting patients with PCOS often depends not only on the established nosological version of pathology, but also from the situation in the family where pregnancy is planned. Taking this into account, the PCC's therapy can be divided into two groups: the basic - when a complex rehabilitation program is long performed and a planned preparation of a young woman to pregnancy occurs, and a situational - when, at the request of the patient, the question of the restoration of fertility is evaluated.

Basic therapy

The arsenal of assistance to patients with PCOS is presented now a large pharmacotherapeutic group of drugs that provide specific and fundamentally excellent one from another impact on different pathogenetic links. An individual set of activities is developed taking into account the presence / lack of instructions on insulin resistance, the image of food behavior and bad habits. Basic therapy provides two main scenarios of treatment: a) for thin without hyperinsulinism - antidegengenic +/- estrogen-gestagenic preparations; b) for all having an overweight body, and for thin with insulin resistance - insulin sensitizers in combination with weight normalization activities.

The most tangible and significant consequence of the opening of the role of insulin resistance in the formation of the PCA has become a new therapeutic technology using medicinal preparations, increasing the sensitivity of insulin receptors. It should be immediately agreed that the Meetform and Glitazon group is shown although the absolute majority of patients, but not everyone. It is clear that in the selection of persons who are shown by insulin-sensitizing drugs, a clear advantage have women that satisfy the criteria for peripheral refractoriness to hormone.

Modern powerful searching systems for scientific and medical literature allow you to track the appearance of the latest data even in remote corners of the planet for several weeks after their appearance in print or in the worldwide network. From the moment of publication in 1994, the articles of the team of authors from Venezuela and the United States on the first experience of the application of metformin at the SPKA took 10 years. Over the years, about 200 more works on this issue appeared. Most of these are information about non-irradiated, uncontrolled and, as a rule, small tests. Such a level of scientific analysis does not satisfy the modern strict requirements imposed on evidence medicine. Therefore, exceptional interest is the publication of systematized analytical reviews and the results of meta-analysis according to summary data from similar tests. Such work appeared only for the last half of the year, and their discussion is important both for practice and for the development of theory. The summary of the most obvious systematically reproducible effects of metformin with PCOS are given below.

Clinical effects

• Improving the menstrual function, induction of spontaneous and stimulated ovulation, increasing the frequency of conception.
• Reducing the frequency of spontaneous miscarriage, reduction of the frequency of gestational diabetes, improve pregnancy outcomes in the absence of teratogenic effect.
• Reduction of hirsutism, acneegee elements, fatty seborrhea, other symptoms of hyperandrode.
• Reducing appetite, body weight, blood pressure.

Laboratory effects

• Reducing insulin levels, insulin-like type 1 growth factor (IFR-1).
• Reducing cholesterol, triglycerides, LDL and LPONP, raising the concentration of HDL.
• Reducing the level of androgens, LH, plasminogen activator inhibitor.
• Increased testosterone-estradiol-binding globulin binding protein for IFR-1.

Russian doctors of different specialties are the most familiar preparation of Siofor 500 and 850 mg (Berlin-Hemi / Menarini GmbH Pharmaceutical), belonging to the insulin sensitizers group. It has become familiar not only for endocrinologists (with the therapy of type 2 diabetes mellitus), but also for gynecologists-endocrinologists - it was from this drug that the history of the treatment of SPI with sensitizers in our country began (M. B. Antsiferov et al., 2001; E. A. Karpova, 2002; N. G. Mishiyeva Sovat., 2001; Mr. E. Chernuha Sovut., 2001).

Dosing mode: The first week \u003d 1 tab. For the night, the second week \u003d + 1 tab. Before breakfast, the third week \u003d + 1 tab. Before lunch. Average daily dose - 1.5-2.5 g

Duration of reception: At least six months, a maximum of 24 months, the average duration is one year.

Break / Cancellation in the drug should be carried out for several days with any acute disease and when conducting x-ray-contrast research on other states (the risk of lactatomocyidosis).

Conclusion

Hyperandrode syndrome is widespread, and the most frequent cause Its development at any age - polycystic ovarian syndrome. The formation of PCOS in children and adolescents serves as a factor in the high risk of not only reproductive disorders, but also a complex of very serious dysmetabolic disorders in childbearing and perimenopausal age. Modern ideas about the pathogenesis and natural evolution of ovarian gyperandrogenation serve as the basis for expanding the testimony for insulin sensitizers, including the Sophophore.

For questions about literature, please contact the editor

D. E. Shilin, Doctor of Medical Sciences, Professor
Russian Medical Academy of Postgraduate Education MZ RF, Moscow

Hyperandrogenation syndrome is a whole group of pathologies that combines an increase in the number or activity of androgen in the body of women. Observed, mainly in adolescent and childbearing age, arises different reasons. The most common - polycystic ovaries, also occurs adrenal hyperandrogenation, congenital, idiopathic, pituitary tumors or ovaries. It is manifested by hirsutism (excessive growth of hair on male type), hyperfunction of sebaceous glands, abdominal obesity, androgenic baldness, in severe cases of atrophy of the mammary glands, uterus, ovaries. Treatment of hyperandrode syndrome depends on the ego of etiology, the degree of manifestations can be conservative or operational.

Gyperandrogenation in women - reasons

Hyperoids in women, her symptoms, may be manifestations of the following diseases:

• Polycystrosis syndrome ovarian
• Hirsutism idiopathicia
• Adrenal hyperandrode congenital
• Cheomatosis stroma ovarian
• Tumors with hyperproduction androgen
• Other reasons

The most common cause of hyperandrode syndrome is SPKA (polycystic ovarian syndrome). It is primary (Stein-Levental syndrome), or secondary, which develops against the background of hypothalamic syndrome, hyperprolactineia, primary hypoteriosis. At the same time, women rises in the blood of cytochrome p, which stimulates androgen products in adrenal glands. In parallel, the resistance of tissues to insulin increases, its products in the pancreas and blood level increase increase. This leads to violation of glucose, fats, purines. An increase in the synthesis of androgens is characteristic of ovarian tumors, hypothalamus, pituitary glands.

In addition to the above mechanisms in occurrence, with hyperandrode, symptoms matters the change in the activity of androgen. It can be associated with insufficient testosterone binding with plasma proteins or a decrease in the number of these proteins. This condition is characteristic of hypothyroidism and lack of androgen. In idiopathic girsutism, the speed of transformation into testosterone and dehydrootestosterone increases, some tissues become more sensitive to their effects. Therefore, with hyperandrode treatment, treatment is necessary even when the level of testosterone in the blood is not increased.

Signs of hyperandrode

Primarily androgens affect sebaceous glands, hair follicles, which leads to seborrhea, hirsutism, baldness. Also, the targets become genitals. Affect androgens and for fat exchange, growth muscular fabric, blood system. They stimulate erythropoes, increase blood clotting, increase the risk of thromboms, including in coronary vessels. When hyperandrode occurs in women: it can be different, but clinical manifestations are always similar.

Gyperandrogenation in women symptoms has three types:

• First - these are dermatological manifestations that can remain the only time for a long time clinical sign Hormonal disorders.
• Second group - Changes in secondary sexual signs.
• To the third group Symptoms associated with tertiary sexual signs, changes in organs and systems that are not directly related to the sexual sphere.

The most sensitive to the effects of androgens are the sebaceous glands that begin under the influence of hormones to highlight an increased amount of sebum. Therefore, symptoms have such as seborrhea, acne, fat skin. The fungal lesion of the skin of the head leads to the occurrence of dandruff. The blockage of the sebaceous glands on the face is the main cause of acne, and as a result of their inflammation, acne appear.

The impact of androgens on hair folkla is caused by hirsutism and androgenic baldness. Most of all are sensitive to hormonal influences of hair in the pubic part, on the inside of the hips, on the stomach and face. Under the influence of testosterone and dehydrootestosterone, they turn from the guns into rigid, because the period of rest of the hair follicles is sharply reduced. On the head (in the temporal and dark part), on the contrary, testosterone causes the elongation of the rest period. Because of which itching the thickening of the hairs, slowing their growth and enhanced loss. Often hyperandrogenation in women symptoms has solely on the side of the skin, while the level of androgens in the blood is normal. This is due to the high activity of 5α-reductase, which turns testosterone into dehydrootestosterone.

Hyperandrogenation of symptoms may have from the side of the genital organs. Basically, they are associated with an absolute increase in androgens. They are manifested by the involution of the mammary glands, a decrease in the size of the uterus and the ovaries, an increase in the size of the clitoris, the withdrawal of the voice. It is often accompanied by a decrease in sexual attraction, signs of depression. In the future, women begins to develop obesity on male type, with an emphasis on the stomach and the upper half of the body, muscle hypertrophy. Blood coagulation may increase, the number of red blood cells in it. All these symptoms are combined with skin manifestations. Most often such common features of hyperandrode are clinical manifestations Polycystic ovarian syndrome or tumors.

Adrenal hyperandrode has a congenital hereditary character. It is connected with the deficiency of the C21-hydroxylase enzyme in the adrenal cortex. It is responsible for steroid synthesis, androgen production increases when it is reduced. The disease can manifest at different ages. In severe cases, at the birth of girls, the female genital atrophy is observed, which often makes it difficult to determine the floor. With an average decrease in the level of enzyme, the disease begins to progress in adolescence. Monthly begins late, in 15-16 years old, they are irregular. Breast glands are poorly developed, there is girsutism, the structure of the figures on the male type, with narrow hips and broad shoulders. Girls in girls are small, sometimes they form men's features. Easy degree Adrenal hyperandrogenation is manifested in young age with minor hirsutism, irregular monthly. Often it becomes the cause of infertility.

Hyperandorogany in women during pregnancy

Hyperandrogenation syndrome often becomes infertility in women. It can manifest itself in the inability to conceive a child and the usual unbearable pregnancy. The ovarian hyperandrode can occur with PCOS, it is the most common cause of high hormone products. In such a situation, the hormonal imbalance is not only observed, but also the anoint cycles in women. The follicle is not developed to the end, and the cell does not leave it, which means the conception is impossible. Adrenal hyperandrode, the treatment of which is quite complicated, can manifest itself as a lack of ovulation and miscarriages at different times.

Hyperandrogenation in women during pregnancy, if the conception took place, can lead to miscarriage at the end of the first trimester and to premature births in the middle of the second. Under the influence of male hormones, poorly developing yellow body Or its involution occurs. This leads to a decrease in the level of progesterone, insufficient endometrial proliferation. As a result, the embryo cannot entrenched in the uterus wall and the pregnancy is interrupted at about 10-12 weeks.

When the hormone synthesis feature takes on the placenta, on July 18-20, the risk of miscarriage decreases. But hyperandrode during pregnancy, the boy can exacerbate, since at the same time the adrenal glands of the fetus begin to produce their own androgens. The manifestation can become Eastic-cervical insufficiency, premature aging of the placenta. If everyone dangerous periods There were safely, there are no special risks for the future child. Sometimes hyperandrode during pregnancy the boy can manifest itself with an increase in the scrotum and the penis after birth, and in girls - swelling of external genital organs. But the phenomenon is temporary and quickly passes.

Hyperandrogenation Syndrome - Diagnostics

Gyperandrogenation in women symptoms has quite pronounced, especially from the side of the skin. Because first diagnostic Event There will be a detailed inspection. The degree of hirsutism is assessed using the Ferriman-Gullewe's index. It shows the intensity of hair growth in the face, shoulders, abdomen, thighs, backs and buttocks. Normally, there must be less than 8, the maximum value is 36. Signs of hyperandrode detects also with standard gynecological inspection, Check the size of the mammary glands, the presence of a colostrum (characterized by hyperprolactinemia), evaluate the structure of the body and the type of fat deposition.

Ovarian hyperandrode

The characteristic symptoms of this form hyperandrode are:

• infertility
• irregular menstruation up to amenorrhea;
• girsutism (overweight rigid and long hair on male type).

Approximately half of women with hyperandogenic ovarian genesis suffer obesity, which confirms the increased body mass index (BMI) - 26.3 ± 0.8. They often observe hyperinsulinemia and insulin resistance, which is rather due to obesity, and not hyperandrogenia. In such patients, diabetes is often developing, so during pregnancy requires control over glucose tolerance. The normalization of carbohydrate metabolism is achieved by reducing body weight, while the level of androgen is reduced.

The methods of diagnosis of ovarian hyperandrode are:

• Hormonal examination

The results of hormonal surveys with ovarian hyperandrode detects:

• high concentration Luteenesium hormone (LH),
• high concentration of testosterone (T),
• increasing the level of follicularity hormone (FSH).

Ultrasound diagnostics with ovarian hyperandrode reveals:

• increasing the volume of ovaries
• stroma hyperplasia
• more than 10 athletic follicles of 5-10 mm in size, located along the periphery under the thickened capsule.

Adrenal hyperandrode

Hyperandrogenation of adrenal genesis is a leading factor in inconsistency in 30% of women with hyperagratenia. The cause of hyperandrogenation in this case is most often the protrudentenital syndrome, which is manifested in the form of a disadvantage or absence of glucocorticoid enzymes for hormonal synthesis in adrenal cortex. In this regard, the development of the disease is possible in childhood.

For the diagnosis of adrenal hyperandrode, primarily produce a survey that is aimed at determining possible deviations From the norm of the level of separate types of hormones and hormonal background as a whole. Mandatory use of ultrasound and other special methods. In the event that the patient was diagnosed during pregnancy, and hyperandrode was detected, then for treatment it will require the purpose of medicines that will contribute to the decrease in androgen. The most suitable and optimal method is selected in each case individually. If the treatment regimen is selected in a timely manner and competently, the conception of the child and the childbirth will soon be permissible.

Hyporandrogenation - Treatment

Is it possible to cure hyperandrode? It all depends on its cause, the severity of the symptoms. The correctly chosen tactics of therapy in many cases allows you to level the symptoms of the disease, as well as solve the problem of infertility. Adrenal hyperandrode treatment provides steroid preparations. They suppress excessive products in the adrenal glands of androgen. During pregnancy, women with such syndrome continue the therapy at least before the end of the first trimester.

Idiopathic hyperandrode in women treatment has a decrease in the peripheral effects of testosterone. It blocks the action of the hormone at the level of the sebaceous glands and hair follicles. Use androgen receptor blockers, for example, flutamide. A good effect has a finastreid, an enzyme inhibitor of 5α-reductase. Spironolactone is not only an aldosterone antagonist, but also in part androgen. It reduces swelling and reduces the activity of male hormones. Also, hyperandrode treatment is carried out by progestains.

The ovarian hyperandrode associated with polycystic disease is treated by suppressing the synthesis of androgen in these organs. Used combined contraceptives, for example, Diana 35. With ineffectiveness, drugs suppress the synthesis of gonadotropic hormones in the pituitary gland and hypothalamus are used. If the tumor of hyperandrogenation in women is caused, the treatment is carried out surgical.

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