Causes and clinical features of 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 of the mother and, at times, virilization of the female fetus. The risk to the fetus depends on a number of factors, including the timing of the excess maternal androgen production, the severity of the increase, and the condition causing the increase. This topic will review the causes and clinical features of gestational hyperandrogenism (table 1). The approach to the patient with gestational hyperandrogenism is discussed separately. (See "Diagnosis and management of gestational hyperandrogenism".)
Normal pregnancy is characterized by a progressive increase in serum total testosterone concentrations, due primarily to an increase in serum sex hormone-binding globulin (SHBG) concentrations, and a late increase in serum free testosterone and androstenedione concentrations (table 2).
The incidence of hyperandrogenism during pregnancy is low, although the incidence of some of the ovarian diseases that can cause it is higher . The two most common causes of gestational hyperandrogenism are luteomas and theca-lutein cysts of the ovary.
An increase in androgen production in a pregnant woman can cause virilization in both the woman and her fetus. The extent of fetal virilization varies, depending on the time of onset of the increased maternal androgen production, its severity, and unknown factors (table 3). For example, fetal virilization is common in virilized pregnant women with luteomas but extremely rare in those with theca-lutein cysts.
Timing of androgen exposure and fetal risk — Female external genital development occurs between 7 and 12 weeks of gestation; androgen exposure during this period may result in partial or complete labial fusion and clitoral hypertrophy. After the 12th week of gestation, clitoral hypertrophy remains a risk, but labial fusion does not occur. Male fetuses are not affected.
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- MATERNAL CAUSES
- Timing of androgen exposure and fetal risk
- Nontumorous ovarian causes
- - Luteomas
- - Theca-lutein cysts
- Role of hCG in androgen excess
- - Ovarian
- Sertoli-Leydig cell tumors
- Krukenberg tumors
- - Adrenal
- Adrenal carcinoma
- Adrenal adenomas
- FETAL CAUSES
- Placental aromatase deficiency