ESPE Abstracts

The source of hyperandrogenism can be adrenal, gonadal, mixed or exogenous. The reason of excessive androgen secretion for age can be primarily gonadal/adrenal or it could be secondary to trophic stimulation (LH, hCG, ACTH, insulin, IGFs). Clinical signs of hyperandrogenism in children include virilization (clitoral hyperplasia, labial fusion, even unclear sex in a newborn), premature pubarche, premature penile growth, accelerated linear growth, increased musculature, acne and/or comedones, adult type body odor, greasy skin and/or hair. Premature adrenarche and precocious puberty (clinical signs before 8 years in girls and 9 years in boys) are the most common hyperandrogenic disorders for age. Congenital virilizing adrenal hyperplasia (CVAH; 21-hydroxylase deficiency the most common form), adrenal and gonadal neoplasms, and exogenous androgen exposure have to be excluded when clinical and laboratory findings do not fit with usually benign marginally premature adrenarche or puberty. Careful clinical evaluation of the child with growth charts and pubertal staging can give clues to the origin of hyperandrogenism. Androgen effects with bilateral testicular enlargement in boys (Tanner G-stage 2 or higher) and breast development in girls (B2 or higher) suggest gonadal origin, androgen effects without testicular enlargement (G1) or breast development (B1) suggest adrenal or exogenous origin of androgens. Initial laboratory tests could include serum 17-OH-progesterone, DHEA(S), androstenedione and testosterone measurements; serum LH, FSH and free beta-hCG (in tumor suspicion) are needed if pubertal development (G2 or higher; B2 or higher) is present. Obesity predisposes to both adrenal and ovarian hyperandrogenism, including polycystic ovarian syndrome (PCOS); fasting plasma glucose, insulin, sex hormone-binding globulin, and lipid measurements are thus relevant. Imaging studies (ultrasonography and/or MRI) are needed when a neoplastic reason for hyperandrogenism is suspected. Management of hyperandrogenism depends on the discovered etiology. CVAH needs careful adjustment of hydrocortisone and possibly fludrocortisone treatment. Surgery is usually needed for neoplastic tumors. Premature adrenarche needs no specific treatment, but overweight should be tried to avoid, as in PCOS.