Causes 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 and virilization during pregnancy are nearly always the result of conditions arising during pregnancy. The reason for this is that hyperandrogenism in a nonpregnant woman usually results in anovulation and infertility, even if the androgen excess is not clinically evident as hirsutism or virilization.
This topic will review these and other rarer causes of this problem (table 1). The diagnosis and treatment of these conditions are discussed elsewhere. (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 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 hirsutism 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.
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