Virilization

Published on 06/06/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 06/06/2015

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Chapter 179 Virilization

INTRODUCTION

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.
Prevalence: Uncommon.
Predominant Age: Reproductive.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

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).
Risk Factors: None known.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Amenorrhea (common but not universal)
• Temporal or frontal balding
• Deepening of the voice
• Clitoral enlargement
• Vaginal dryness
• Increased muscle mass
• Male-pattern hair growth

DIAGNOSTIC APPROACH

Differential Diagnosis

• Iatrogenic or exogenous steroid use
• Polycystic ovary syndrome
• Ovarian stromal hyperthecosis
• Ovarian tumors (Sertoli-Leydig tumors)
• Cushing’s disease (truncal obesity, facial rounding, cervicodorsal fat deposition [buffalo hump], and red or purple striae are often not fully developed)
• Adrenal tumors
• Congenital adrenal hyperplasia (especially in infants and children)

Associated Conditions: Defeminization, amenorrhea, obesity, menstrual irregularity, amenorrhea, infertility, acne, oily skin, increased libido, and alopecia.

Workup and Evaluation

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.
Imaging:

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