Androgen Excess Disorders in Women pp 107-119

Part of the Contemporary Endocrinology book series (COE)

Pregnancy-Related Androgen Excess

  • Howard D. McClamrock


Pregnancy-related androgen excess and virilization almost always arise from conditions occurring during pregnancy. It is often stressful and challenging for the clinician because of the need for a timely diagnosis in order to estimate the likelihood of virilization of an unborn female fetus. Androgen excess in pregnancy is relatively rare; the two most common causes are gestational luteoma and hyperreactio luteinalis (theca-lutein cysts of the ovaries). Increases in androgen production in pregnant women may cause hirsutism and virilization of the mother and at times virilization of a female fetus. The risk to the fetus depends on a number of factors, including the onset of increased maternal androgen production, the severity of the increase, and the condition causing the increase. Luteoma should be suspected in women with unilateral or bilateral (47%) solid ovarian masses, whereas Krukenberg tumor remains a possibility, especially in those with bilateral lesions. The natural course of the luteoma is regression and disappearance of the lesion after delivery, and it appears that elevated cord levels of testosterone and/or androstenedione are necessary for virilization of a female fetus based on a few reported cases. Hyperreactio luteinalis should be suspected in pregnancies complicated by androgen excess with bilateral cystic ovaries noted on exam or ultrasound. This condition does not appear to put the female fetus at risk for virilization even in situations in which circulating maternal androgens are high. As with luteoma, these cysts normally regress after delivery and should not require surgical therapy. Consideration should always be given to exogenous hormone therapy in pregnancies complicated by androgen excess. Unilateral solid ovarian lesions in pregnancies complicated by androgen excess increase the risk of malignancy. Current management is mostly limited to evaluating the risk to the fetus rather than implementing intervention that may alter the course of the pregnancy.

Key Words

Gestational hyperandrogenism androgen excess in pregnancy maternal/fetal masculinization virilization virilization hyperreactio luteinalis (theca-lutein cysts) luteoma pregnancy complication 


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Copyright information

© Humana Press Inc., Totowa, NJ 2006

Authors and Affiliations

  • Howard D. McClamrock
    • 1
  1. 1.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Reproductive SciencesUniversity of Maryland School of MedicineBaltimore

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