11 - Treatment of hyperandrogenism in polycystic ovary syndrome

Summary

Introduction

Hyperandrogenism is the most common endocrinopathy seen in women and may result from ovarian or adrenal overproduction of androgens, altered peripheral metabolism and/or end-organ hypersensitivity. Androgen excess can have profound effects on human skin, especially the skin appendages, sebaceous glands and hair follicles, which are strongly dependent on biologically active androgens.

The development of sudden-onset acne and/or hirsutism, female-pattern hair loss, irregular menses, increased libido, acanthosis nigricans, deepening voice, clitoromegaly or other signs of hyperandrogenism such as cushingoid features requires further investigation. It is important to recognise that women with hyperandrogenism may also have insulin resistance that puts them at increased risk of developing diabetes and cardiovascular disease. The treatment of these women should be managed by an endocrinologist and a gynaecologist to ensure that a comprehensive approach is adopted. The most common cause of hyperandrogenism in women is polycystic ovary syndrome (PCOS) but congenital adrenal hyperplasia as well as ovarian and adrenal tumours may need to be considered.

In the sebaceous gland, androgens stimulate sebocyte proliferation. This is most pronounced in facial sebocytes and leads to increased sebum production. Within the intrafollicular duct of the pilosebaceous unit, androgens increase the rate of mitosis and epithelial proliferation, leading to hyperkeratosis. These events contribute to the pathogenesis and subsequent development of clinical acne.