Approach to the patient with gestational hyperandrogenism
- Howard D McClamrock, MD
Howard D McClamrock, MD
- Clinical Associate Professor of Obstetrics and Gynecology
- University of Maryland School of Medicine
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
Hyperandrogenism in pregnant women may cause hirsutism and virilization in the woman and virilization of female fetuses. This topic will review the diagnostic approach and management of pregnant women presenting with new hyperandrogenism. The major causes and clinical features of gestational hyperandrogenism are discussed in detail elsewhere (table 1 and table 2). The management of the virilized infant is also reviewed separately. (See "Causes and clinical features of gestational hyperandrogenism" and "Management of the infant with atypical genitalia (disorder of sex development)".)
Hyperandrogenism in pregnant women may cause hirsutism and virilization of the mother and, more variably, virilization of any female fetuses. The fetal risk depends on a number of factors including the timing of the excess maternal androgen production, the severity of this increase, and the condition(s) causing the increase.
The possibility of androgen excess usually arises when a pregnant woman presents with the rapid onset of masculinization (virilization). Affected women may have a variety of symptoms including hirsutism (at times requiring shaving), acne, temporal balding, clitoromegaly, and deepening of the voice.
There may also be a palpable abdominal mass due to a tumor or cyst. Causes of the masses include luteomas, theca-lutein cysts, other ovarian tumors, and adrenal tumors. No masses would be expected when the etiology is exposure to exogenous hormones or placental aromatase deficiency. (See "Causes and clinical features of gestational hyperandrogenism".)
At other times, gestational hyperandrogenism is first suspected at the time of delivery of a virilized female infant. If the investigation begins after delivery, one must keep in mind that luteomas and theca-lutein cysts undergo spontaneous regression after delivery, ie, maternal surgical intervention is not required. (See "Causes and clinical features of gestational hyperandrogenism".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DIAGNOSTIC APPROACH
- Risk of fetal virilization
- Hormone determinations
- Pelvic ultrasound
- - Ovarian cysts
- - Ovarian masses (solid)
- - No ovarian mass
- Adrenal imaging
- Additional evaluation
- - Determine fetal sex
- Cell-free fetal DNA
- - Ovarian cystic mass
- Rule out trophoblastic disease
- - Solid mass benign or malignant?
- Diagnostic laparoscopy
- DIFFERENTIAL DIAGNOSIS
- Ovarian sources of androgens
- - Benign
- Gestational ovarian theca-lutein cysts
- - Virilizing ovarian tumors
- Adrenal sources
- - Adrenal adenomas
- - Adrenocortical carcinoma
- Exogenous androgen exposure
- Placental aromatase deficiency
- SUMMARY AND RECOMMENDATIONS