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Cited by 1,132Ovarian function and disordersSexual Differentiation and DisordersAdrenal Hormones and Disorders

Androgen Excess in Women: Experience with Over 1000 Consecutive Patients

Azziz, R., Sanchez, L. A., Knochenhauer, E. S., Moran, C., Lazenby, J., Stephens, K. C., Taylor, K., Boots, L. R.·2004·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2003-031122
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Abstract

The objective of the present study was to estimate the prevalence of the different pathological conditions causing clinically evident androgen excess and to document the degree of long-term success of suppressive and/or antiandrogen hormonal therapy in a large consecutive population of patients. All patients presenting for evaluation of symptoms potentially related to androgen excess between October 1987 and June 2002 were evaluated, and the data were maintained prospectively in a computerized database. For the assessment of therapeutic response, a retrospective review of the medical chart was performed, after the exclusion of those patients seeking fertility therapy only, or with inadequate follow-up or poor compliance. A total of 1281 consecutive patients were seen during the study period. Excluded from analysis were 408 patients in whom we were unable to evaluate hormonal status, determine ovulatory status, or find any evidence of androgen excess. In the remaining population of 873 patients, the unbiased prevalence of androgen-secreting neoplasms was 0.2%, 21-hydroxylase-deficient classic adrenal hyperplasia (CAH) was 0.6%, 21-hydroxylase-deficient nonclassic adrenal hyperplasia (NCAH) was 1.6%, hyperandrogenic insulin-resistant acanthosis nigricans (HAIRAN) syndrome was 3.1%, idiopathic hirsutism was 4.7%, and polycystic ovary syndrome (PCOS) was 82.0%. Fifty-nine (6.75%) patients had elevated androgen levels and hirsutism but normal ovulation. A total of 257 patients were included in the assessment of the response to hormonal therapy. The mean duration of follow-up was 33.5 months (range, 6-155). Hirsutism improved in 86%, menstrual dysfunction in 80%, acne in 81%, and hair loss in 33% of patients. The major side effects noted were irregular vaginal bleeding (16.1%), nausea (13.0%), and headaches (12.6%); only 36.6% of patients never complained of side effects. In this large study of consecutive patients presenting with clinically evident androgen excess, specific identifiable disorders (NCAH, CAH, HAIRAN syndrome, and androgen-secreting neoplasms) were observed in approximately 7% of subjects, whereas functional androgen excess, principally PCOS, was observed in the remainder. Hirsutism, menstrual dysfunction, or acne, but not alopecia, improved in the majority of patients treated with a combination suppressive therapy; although more than 60% experienced side effects.

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  • Hyperandrogenism can occur without cutaneous manifestations even though hirsutism is common among women with hyperandrogenism.

    “Even though hirsutism is common among women with hyperandrogenism, the latter can occur in the absence of cutaneous manifestations [2,3]”

    From The Diagnosis of Polycystic Ovary Syndrome during Adolescence (2015) · cites this paper as [2]

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Authors
Azziz, R., Sanchez, L. A., Knochenhauer, E. S., Moran, C., Lazenby, J., Stephens, K. C., Taylor, K., & Boots, L. R.
Affiliations
University of Alabama at Birmingham (US)
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2004-02
Volume
89
Issue
2
Pages
453-462
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2003-031122
OpenAlex
W2163069137
Cited by
1,132
References
60
Citations by year
2026: 19 · 2025: 33 · 2024: 35 · 2023: 36 · 2022: 53 · 2021: 34 · 2020: 48 · 2019: 41 · 2018: 279 · 2017: 62 · 2016: 39 · 2015: 65 · 2014: 51 · 2013: 50 · 2012: 45
FWCI
31.82
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • University of Alabama at Birmingham
  • National Institutes of Health
  • National Institute of Diabetes and Digestive and Kidney Diseases (K24-DK01346)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD029364, R01-HD29364)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
hyperandrogenism, polycystic ovary syndrome, hirsutism, 21-hydroxylase deficiency, adrenal hyperplasia, insulin resistance, antiandrogen therapy, hormone therapy response, prevalence, acne, menstrual disorders, hair loss, treatment side effects, long-term follow-up
MeSH terms
Acanthosis Nigricans, Adrenal Hyperplasia, Congenital, Adult, Androgen Antagonists, Androgens, Endocrine Gland Neoplasms, Female, Humans, Retrospective Studies, Time Factors, Prevalence, Treatment Outcome, Hyperandrogenism

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