PATHOPHYSIOLOGY, GENETICS, AND TREATMENT OF HYPERANDROGENISM

Hirsutism and virilism are common presenting complaints of many patients. Hirsutism may include generalized increases in body hair and may be idiopathic, genetic, or induced by drugs. Drug-induced hirsutism, or hypertrichosis, does not follow the bodily distribution of the hair associated with male secondary sexual characteristics. By contrast, virilism is mediated by androgens; therefore, an understanding of androgen biosynthesis must underlie any consideration of disorders of hyperandrogenism. Hyperandrogenic disorders can present in childhood as contrasexual virilization in girls or as precocious pseudopuberty in boys. With the exception of very rare androgen-secreting tumors and a rare genetic disorder of gonadotropin receptors, these disorders are caused by genetic lesions in the enzymes for steroid hormone synthesis.