|Geisthövel F et al. |
Novel Systematics of Nomenclature and Classification of Female Functional Androgenization (Including Polycystic Ovary Syndrome and Non-Classic Congenital Adrenal Hyperplasia)
Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (1)
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Abbildung 1: Nomenclature and algorithm of classification of female androgenization. Diagnostic level I is the screening
step regarding clarification of functional androgenization (FA), and/or of cycle irregularities, and/or of infertility, particularly
in the combination with obesity (especially in adolescence). If e.g. elevated C19-sex steroid levels or low
SHBG levels are found, diagnostic level II (see Material and Methods) will follow. At least on this step, areas A to C
can be differentiated. In most cases, area A, the FA, will come in consideration. This area can be further divided
through step II into groups FCA (skin) and FAS I (ovary), II (adrenal gland), III (multi-organ FA disordes), and IV (residual
FA dysfunctions/disorders) (see Material and Methods). When very high serum levels of testosterone and/or DEHAS
are found, the dexamethasone test (level III) may be used in order to differentiate a functional adrenal hyperandrogenaemia
(FAS II) from a non-functional androgen excess which might suscpicous for a tumerous androgenization
(Area B) (data not shown). In addition, it has to be clarified on level II (e.g. by pathologic 17-hydroxy progesterone
levels), whether a CYP21A analysis should follow (level III). On the other hand, by an accurate enquiry concerning the
use of medicine just at the beginning of the medical care it will be found out whether area C (pharmaceutical androgenization)
has to be considered.
PFOs: polyfollicular ovaries; DHEAS: dehydroepiandrosterone-sulphate; SHBG: sex hormone-binding globulin; A:
functional androgenization; B: tumorous androgenization; C: pharmacological androgenization; FCA: functional cutaneous
androgenization; FAS: functional androgenizing syndrome.
Abbildung 2: Box plots of selected major primary (classifying) variables in all groups of patients with functional androgenization. Results of classification of functional androgenization
summarizing full-blown and minimum standard core/miscellanous clusters (subgroups a and b, respectively). Statistically significant differences among the groups are shown
in detail in Table 8.
FCA: functional cutaneous androgenization; FAS: functional androgenizing syndrome. Insulin 1: 1-h post-load insulin. Results are shown as median (line within in the box), mean
(dot within the box), 75th and 25th percentiles (upper and lower limits of the box), maximum observation below upper fence ( ), minimum observation above lower fence (⊥) and
maximum observation (□). Dotted lines represent the respective cut-off values: LH (8.4 mIU/mL), testosterone (2.1 nmol/L), free androgen index (5), serum insulin 1 (723 pmol/
Abbildung 3: Box plots of serum lipids, the major secondary (facultative) variable, in all groups of patients with functional androgenization.
For legend see Figure 2. Dotted lines represent the respective cut-off values: triglycerides (150 mg/dL), high density lipoprotein (HDL)-cholesterol (50 mg/dL).
Statistically significant differences are:
FCA vs. III, IV 0.0021, 0.0301
FAS I vs. III, IV < 0.0001, 0.0161
FAS III vs. II, C 0.0014, 0.0003
FAS I vs.II–IV 0.0306, < 0.0001, 0.0003
FAS III vs. FCA, C 0.0173, 0.0001
FAS IV vs. C 0.0030