[Hyperandrogenism after menopause: Ovarian or adrenal origin?]

Area of Science:

• Endocrinology
• Reproductive Medicine
• Oncology

Background:

• Postmenopausal hyperandrogenism involves androgen excess from adrenal or ovarian sources.
• Symptoms range from moderate (hirsutism, acne) to severe (virilization, alopecia).
• Rare but critical to exclude are androgen-secreting tumors, including adrenal tumors.

Purpose of the Study:

• To review hormonal measurements and imaging techniques for identifying the origin of androgen excess.
• To assess the utility of testosterone (T), delta 4 androstenedione, 17 OH progesterone, SDHEA, FSH, and LH.
• To evaluate the role of pelvic ultrasound, MRI, and adrenal CT scans in diagnosis.

Main Methods:

• Review of hormonal assays including T, delta 4 androstenedione, 17 OH progesterone, SDHEA, FSH, and LH.
• Analysis of imaging modalities: pelvic ultrasound, pelvic MRI, and adrenal CT scan.
• Correlation of clinical presentation (hirsutism, alopecia progression) with diagnostic findings.

Main Results:

• Rapid progression of hirsutism and/or alopecia, along with elevated serum testosterone levels, suggests a tumorous cause.
• Pelvic MRI is effective for evaluating ovarian and pelvic sources of androgen excess.
• Adrenal CT scans are crucial for identifying adrenal tumors contributing to hyperandrogenism.

Conclusions:

• A combination of specific hormonal measurements and advanced imaging is essential for diagnosing postmenopausal hyperandrogenism.
• Distinguishing between adrenal and ovarian sources, and ruling out tumors, is critical for appropriate patient management.
• MRI and CT scans are valuable tools for localizing the source of androgen excess.