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Pregnancy-Related Androgen Excess

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Androgen Excess Disorders in Women

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

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.

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Author information

Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD

    Howard D. McClamrock

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  1. Howard D. McClamrock
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Editors and Affiliations

  1. Center for Androgen Related Disorders, Cedars-Sinai Medical Center; and Department of Obstetrics and Gynecology, and Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, CA

    Ricardo Azziz MD, MPH, MBA

  2. Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA

    John E. Nestler MD

  3. Department of Endocrine Gynaecology and Reproductive Medicine, Lille University Hospital, Lille, France

    Didier Dewailly MD

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© 2006 Humana Press Inc., Totowa, NJ

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McClamrock, H.D. (2006). Pregnancy-Related Androgen Excess. In: Azziz, R., Nestler, J.E., Dewailly, D. (eds) Androgen Excess Disorders in Women. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-179-6_9

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  • DOI: https://doi.org/10.1007/978-1-59745-179-6_9

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-663-4

  • Online ISBN: 978-1-59745-179-6

  • eBook Packages: MedicineMedicine (R0)

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