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Diagnosis and management of gestational hyperandrogenism

Howard D McClamrock, MD
Section Editors
Robert L Barbieri, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD


Hyperandrogenism in pregnant women may cause hirsutism and virilization in the woman and virilization of female fetuses. The major causes of gestational hyperandrogenism and some of their clinical characteristics are shown in the tables (table 1 and table 2). These disorders are discussed in detail elsewhere (see "Causes of gestational hyperandrogenism"). This topic will review the clinical manifestations, diagnosis, and treatment of hyperandrogenism in pregnant women.


The possibility of androgen excess usually arises when a pregnant woman presents with the rapid onset of masculinization. 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 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.


When evaluating a woman with gestational hyperandrogenism, the possibility that a masculinizing lesion may be malignant is sufficient to warrant a thorough evaluation (algorithm 1) [1,2]. Examples of malignant tumors associated with gestational hyperandrogenism include Sertoli-Leydig cell tumors, granulosa-theca cell tumors, Krukenberg tumors, ovarian mucinous cystadenocarcinomas, and adrenocortical carcinomas. Although very rare in pregnancy, Cushing's syndrome should also be considered.


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Literature review current through: Sep 2016. | This topic last updated: Jun 11, 2015.
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