Virilism


Virilism

Description, Causes and Risk Factors:

ICD-10-DC: E25.9.

Possession of mature masculine somatic characteristics by a girl, woman, or prepubescent male; may be present at birth or may appear later, depending on its cause; may be relatively mild (e.g., hirsutism) or severe and is commonly the result of gonadal or adrenocortical dysfunction, or of Androgenic therapy. Type of virilism produced by excessive or abnormal secretory patterns of adrenocortical steroids.

In the normal human body, there are two adrenal glands. They are small structures that lie on top of the kidneys. The adrenal glands produce many hormones that regulate body functions. These hormones include androgens, or male hormones. Androgens are produced in normal girls and women. Sometimes, one or both of the adrenal glands becomes enlarged or overactive, producing more than the usual amount of androgens. The excess androgens create masculine characteristics.

The most common conditions causing virilism in women are:

    Polycystic ovary syndrome (PCOS) usually presents with irregular periods, infertility or hirsutism. Mostly these women are also obese. Diagnosis is mostly confirmed by ultrasound when multiple cysts are found in the ovaries. Characteristic pattern of hormonal abnormalities display an elevated ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH). There is also usually evidence of high concentrations of male hormones such as androstenedione, testosterone, and DHEAS.

  • Congenital adrenal hyperplasia (CAH) affects steroid production in the adrenal glands. The 21-hydroxylase deficiency is the most common deficiency that leads to decreased production of cortisol and aldosterone with increased androgen secretion.

  • Idiopathic hirsutism - Though there is no evidence of any disease, excess androgen is present in 5 to 15% of hirsute patients. Many medications can also cause hirsutism.

If a cancerous tumor has caused the disorder, patients have a better prognosis if they have an early stage of cancer that is diagnosed quickly.

Survey of the Literature and report on 5 cases of virilism. In three of these patients the symptoms were supposed to be due to an arrhenoblastoma (a kind of ovarian tumor) involving one of the ovaries. The findings in these patients conform the degree of masculinization is most pronounced in case the tumor is in a less advanced stage of differentiation and only slightly pronounced if the tumor microscopically resembles a tubular adenoma. Two of the three patients with an arrhenoblastoma are still alive, two and a half years and four years respectively after ovariotomy. In the third patient there was evidence of a local recurrence of osteoblastic metastases to the skeleton already three and a half months after operation. In view of this and similar cases Röntgen treatment should be taken into consideration as soon as a masculinizing tumor is removed even if it is not possible to furnish microscopical evidence of malignancy.

The remaining two patients manifested Cushing's syndrome. In both patients the signs and symptoms were strongly pronounced. After a careful examination the Cushing's syndrome was accredited to a pathologic condition of the hypophysis, and Röntgen treatment was considered indicated. Since so many authors emphasize the unfavorable result of an explorative denudation of the adrenal glands in patients suffering from Cushing's syndrome this method of examination was not used in the two cases under study. In one of the patients three series of Röntgen treatment to the hypophysis were given and in the other two series. The treatment resulted in a considerable improvement in both patients. In the last three years they were able to work normally. One of them is free from evidence of the disease and the ovaries seem to function normally. Although there may have been a spontaneous cure in these cases, the improvement subsequent to the irradiation not only suggests that the favorable results obtained were due to the treatment, but also encourages further attempts with irradiation in cases of Cushing's syndrome, where there is reason to assume that the hypophysis is involved.

Symptoms:

Typically, their menstrual cycles are infrequent or absent. They may also develop a deeper voice, hirsutism, laryngeal prominence (Adam's apple), excessive oily skin leading to acne and seborrhea, hidradenitis suppurativa, increased libido, hypertension, cardiovascular abnormalities, and insulin resistance.

Diagnosis:

A complete History & Physicalshould be done. If a patient has moderate-to-severe symptoms, an early morning blood sample is taken to check total testosterone. This can be followed by a free testosterone level if the total testosterone is moderately elevated. A tumor should be suspected if the total testosterone level > 200 ng/dL. A palpable abdominal or pelvic mass may also be felt. Other tests may be done based on clinical suspicion and these may include thyroid function tests (TFTs), prolactin level, 17-hydroxyprogesterone level, and corticotropin stimulation test.

Imaging: Abdominal ultrasound, CT, MRI: If suspected PCOS, adrenal or ovarian tumor. MRI brain scan: If suspected pituitary tumor.

Treatment:

Patients with mild symptoms and normal menses can be treated empirically. Oral contraceptives can be given to correct hormonal imbalances to women who don't desire pregnancy. Treatment of the underlying cause by a Qualified physician or surgeon is required in certain cases such as tumors and can give good results.

For cosmetic appearance, cosmetic treatment includes hair removal. Repeated shaving and waxing is effective but needs to be repeated often. Some people opt for electrolysis and Laser therapy even though long term evidence of permanent results is limited. Vaniqa™ (eflornithine hydrochloride), a topical agent may also be used.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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