Virilization E25.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Masculinization; Virilism; Virilization

Definition
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Development of male secondary sexual characteristics (male hair type = hirsutism, deep voice, clitoral hypertrophy) in women with obligatory increased androgen formation (e.g. in PCOS, SAHA syndrome, ovarian tumours, NNR tumours, exogenous androgen supply).

Etiopathogenesis
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Endogenous or exogenous androgen supply.

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Clinical features
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Body and sexual hair in women corresponding to the male hair type, which is ovarian, adrenal or pituitary.

Laboratory
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Differently pronounced hyperandrogenemia. There is not always a firm correlation between the concentration of circulating androgens and the clinical signs of androgenization. This means that, in addition to the bioavailability of androgens, the rate of utilisation in the target organs plays a role in clinical androgenic effects.

Therapy
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  • Causal therapy, if possible. Tumour search and, if necessary, remediation. Stop exogenous supply of hormone-containing substances. Otherwise antiandrogenic therapy with cyproterone acetate (e.g. Androcur) 2 mg/day in combination with ethinylestradiol 0.05 mg/day (e.g. Diane). Alternatively cyproterone acetate 2 mg/day in combination with ethinylestradiol 0.035 mg for 21 days, then 7 days rest, alternating over months to years. For more severe disorders Cyproterone acetate 25-200 mg/day for 10 days, 18 days break, in combination with ethinylestradiol (progynone) 0.04 mg/day, 21 days therapy, then 7 days break.
  • High-dose parenteral therapy (in case of failure of oral therapy): 300 mg cyproterone acetate (Androcur Depot) i.m. between the 3rd and 7th day of the cycle combined with 40 μg/day ethinylestradiol starting on the day of CPA injection, for 20 days.

Literature
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  1. Breckwoldt M (1992) Diagnosis and therapy of androgenisation symptoms in women. Diesbach publishing house
  2. Goodarzi MO et al (2003) Virilization in bilateral macronodular adrenal hyperplasia controlled by luteinizing hormones. J Clin Endocrinol Metab 88: 73-77
  3. Mantovani G et al (2003) Isolated follicle-stimulating hormone (FSH) deficiency in a young man with normal virilization who did not have mutations in the FSHbeta gene. Fertil Sterile 79: 434-436

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Last updated on: 29.10.2020