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Causes and clinical features of gestational hyperandrogenism

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

INTRODUCTION

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. However, normal women do not experience symptoms or signs of hyperandrogenism (acne, hirsutism) as a result of this physiologic rise in androgen concentrations, probably due to the overwhelming increases in estrogens associated with pregnancy that mitigate this small degree of unsustained hyperandrogenemia during the end of gestation. 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 "Approach to the patient with gestational hyperandrogenism".)

MATERNAL CAUSES

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 [1]. 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 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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Literature review current through: Sep 2017. | This topic last updated: Sep 25, 2017.
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