Hyperandrogenism and AUB Management

Hyperandrogenism and AUB Management

Discuss and described the pathophysiology and symptomology/clinical manifestations of Hyperandrogenism.
Discuss three differential diagnoses for AUB with ICD 10 numbers for each.
Discuss patient education.
Develop the management plan (pharmacological and nonpharmacological).

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Hyperandrogenism and AUB Management

1. Pathophysiology and Clinical Manifestations of Hyperandrogenism

Pathophysiology of Hyperandrogenism

Hyperandrogenism is characterized by excess levels of androgens (male hormones such as testosterone, DHEA-S, and androstenedione) in females. These androgens are primarily produced by the ovaries, adrenal glands, and peripheral tissues (such as adipose tissue). The excessive production of androgens disrupts normal hormonal balance and leads to clinical manifestations.

Key mechanisms leading to hyperandrogenism include:

Polycystic Ovary Syndrome (PCOS): The most common cause, where ovarian dysfunction results in increased androgen production.
Congenital Adrenal Hyperplasia (CAH): A genetic disorder leading to excessive adrenal androgen production due to enzyme deficiencies (e.g., 21-hydroxylase deficiency).
Androgen-secreting tumors: Ovarian or adrenal tumors that produce excessive androgens.
Cushing’s Syndrome: Hypercortisolism leading to increased adrenal androgen secretion.
Insulin Resistance & Hyperinsulinemia: Insulin stimulates ovarian theca cells, leading to increased androgen production.

Clinical Manifestations of Hyperandrogenism

Hirsutism: Excessive hair growth in a male-pattern distribution (e.g., face, chest, back).
Acne and Seborrhea: Increased sebum production leading to persistent acne.
Androgenic Alopecia: Thinning of scalp hair, often in a male-pattern baldness distribution.
Clitoral Hypertrophy: Enlargement of the clitoris in severe cases.
Menstrual Irregularities: Oligomenorrhea (infrequent menstruation) or amenorrhea (absence of menstruation).
Deepened Voice: Due to laryngeal hypertrophy in severe cases.
Increased Muscle Mass: In extreme cases of androgen excess.
Acanthosis Nigricans: A sign of insulin resistance, often seen in PCOS-related hyperandrogenism.

2. Differential Diagnoses for Abnormal Uterine Bleeding (AUB)

Abnormal Uterine Bleeding (AUB) is a broad term describing irregular, heavy, or prolonged menstrual bleeding. The FIGO (International Federation of Gynecology and Obstetrics) classification (PALM-COEIN) system categorizes AUB into structural (PALM) and