Chapter 179 Virilization
Description: Virilization refers to the loss of female sexual characteristics such as body contour and the acquisition of masculine qualities such as increased muscle mass, temporal balding, deepening of the voice, and clitoromegaly.
Causes: Idiopathic ovarian (polycystic ovary syndrome, hilus cell hyperplasia/tumor, arrhenoblastoma, adrenal rest), adrenal (congenital adrenal hyperplasia [10% to 15% of women with hirsutism], Cushing disease, virilizing carcinoma or adenoma), drugs (minoxidil, androgens including danazol [Danocrine], phenytoin, diazoxide), pregnancy (androgen excess of pregnancy, luteoma, or hyperreactio luteinalis).
• Cushing’s disease (truncal obesity, facial rounding, cervicodorsal fat deposition [buffalo hump], and red or purple striae are often not fully developed)
Laboratory: Prolactin, follicle-stimulating hormone (FSH), thyroid screening. Patients suspected of having adrenal sources of hyperandrogenicity may be screened by measuring 24-hour urinary-free cortisol, by performing adrenocorticotropin hormone (ACTH) stimulation tests, or by performing an overnight dexamethasone suppression test. Dehydroepiandrosterone sulfate (DHEA-s) and testosterone should be measured. The circulating testosterone level is generally ≥2 ng/mL.