绝经后女性高雄激素血症1例并文献复习

朱伊祎; 虞睿琪; 袁涛; 张化冰; 王曦; 王林杰; 伍学焱

doi:10.16766/j.cnki.issn.1674-4152.003142

绝经后女性高雄激素血症1例并文献复习

doi: 10.16766/j.cnki.issn.1674-4152.003142

中国医学科学院北京协和医学院北京协和医院内分泌科国家卫生健康委员会内分泌重点实验室疑难重症及罕见病国家重点实验室，北京 100730

基金项目:

中央高水平医院临床科研项目 2022-PUMCH-A-064

详细信息

通讯作者:
王林杰，E-mail：eileenwood@163.com

中图分类号: R588 R586.25
计量
- 文章访问数: 144
- HTML全文浏览量: 41
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-22
- 网络出版日期: 2023-09-13

Hyperandrogenism in postmenopausal women: a case report and literature review

State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

摘要

摘要: 患者女性，71岁。自绝经10年后逐渐出现多毛症、脱发、阴蒂肥大，曾多次查血总睾酮水平升高(1.55~1.79 ng/mL，正常范围为0.08~0.60 ng/mL)，硫酸脱氢表雄酮不高，影像学未见肾上腺及卵巢占位，考虑到患者高龄且合并多种代谢并发症，腹腔镜探查手术风险高，试用促性腺激素释放激素类似物曲普瑞林治疗。32周后，患者毛发变软、脱落，监测黄体生成素从31 IU/L降至0.2 IU/L，睾酮回落至正常(0.47 ng/mL)，复查影像学未见肿瘤转移或卵巢增大征象。同时，联合生活方式干预以及降脂治疗，可改善患者代谢异常、减轻心理焦虑，提高生活质量。
- 绝经后高雄激素血症 /
- 促性腺激素释放激素类似物 /
- 多毛症 /
- 代谢异常 /
- 心理健康
Abstract: A 71-year-old female complained of hirsutism, androgenetic alopecia and enlarged clitoris after 10 years of post-menopause. Laboratory examination of total testosterone level was elevated (1.55-1.79 ng/mL, reference range: 0.08-0.60 ng/mL), while dehydroepiandrosterone sulfate was within normal range. No obvious adrenal or ovarian mass was shown on imaging. Laparoscopy exploration was refused owing to advanced age and multiple comorbidities. After the 8-month trial of gonadotropin-releasing hormone analogue triptorelin, improved hirsutism and reduced androgenetic alopecia were observed, with decreased luteinizing hormone levels from 31 to 0.2 IU/L and normalized testosterone levels to 0.47 ng/mL. No signs of tumor metastasis or ovarian enlargement were found on imaging examination. At the same time, the combination of lifestyle intervention and lipid lowering treatment can improve patients ' metabolic abnormalities, alleviate psychological anxiety, and improve their quality of life.
- Postmenopausal hyperandrogenism /
- Gonadotropin-releasing hormone analogue /
- Hirsutism /
- Metabolic abnormality /
- Psychological well-being

HTML全文

图 1 患者治疗前多毛症体征

Figure 1. Patient's hirsutism sign before treatment

下载: 全尺寸图片幻灯片

图 2 肾上腺CT平扫

注：A为冠状位，B、C为矢状位。箭头示肾上腺。

Figure 2. CT scan of the patient's bilateral adrenal glands (Arrows: adrenal glands)

下载: 全尺寸图片幻灯片

图 3 患者诊疗期间促性腺激素以及睾酮水平变化趋势示意图

Figure 3. Schematic diagram of patient gonadotropin and testosterone levels during the diagnosis and treatment

下载: 全尺寸图片幻灯片

图 4 绝经后女性高雄激素血症的诊治流程图

Figure 4. Flowchart for hyperandrogenism diagnosis and treatment in postmenopausal women

下载: 全尺寸图片幻灯片

表 1 中剂量地塞米松抑制试验结果

Table 1. Results of the medium dose dexamethasone suppression test

项目	促肾上腺皮质激素(pg/mL)	睾酮 (ng/mL)	17α羟孕酮 (ng/mL)
服药前	26.30	1.55	0.59
服药后	< 1.50	1.01	0.27
抑制率(%)		34.8	54.2

下载: 导出CSV

参考文献(15)

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