Abbildung 1: Female androgenization
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.