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): 6-26

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Keywords: acne,  AGS,  alopecia,  Androgenization,  classification,  Diabetes,  hirsutism,  hyperandrogenemia,  hyperinsulinaemia,  metabolic syndrome,  NC-CAH,  obesity,  PCOD,  PCOS

Objective: A novel nomenclature as well as a comprehensive, clearly defined classification of functional androgenization (FA) from puberty well into postmenopause have been developed. Data are presented indicating the applicability of this algorithm. Design: Retrospective case-control study involving FA-patients, and controls (C). Methods: FA-patients were classified into five groups, functional cutaneous androgenization (FCA: skin) as well as functional androgenizing syndrome (FAS) I (ovary), II (adrenal), III (multi-organ-disorder with FA, obesity, hyperinsulinaemia) and IV (residual FA dysfunctions) using group-specific variable clusters. They are set up by primary (classifying) variables such as cutaneous androgenetic symptoms (acne vulgaris, hirsutism, androgenetic alopecia), body mass index (BMI), testosterone, free androgen index (FAI), polyfollicular ovaries (PFOs), and 1-h-insulin (after oral glucose loading). Groups FCA and FAS I–III were sub-classified through classic full-blown (“a”) and non-classic, minimum standard core/miscellaneous clusters (“b”). Variables were allocated as integral part of different clusters (e.g. enhanced BMI: in FCAb, FAS IIb, FAS IIIa/b, and FAS IV). Patients’ complete characterization was achieved additionally by using secondary (facultative) variables, e.g. triglycerid levels. Results: The FA-groups included 6, 33, 10, 59, and 18 subjects. All FCA-patients presented cutaneous androgenetic symptoms, PFOs were visualized in all FAS I and III patients. Group FAS Ia showed highest LH levels, and testosterone was higher in FAS I vs. FCA, FAS II, FAS IV and C. Levels of DHEAS were found to be highest in group FAS II. BMI and triglycerids were higher in FAS III vs. FCA, FAS I, FAS II, and C, and one-hr-insulin in FAS III was higher vs. FCA, FAS I, and C. In FAS IV covering the residual FA-patients, several obese, hyperinsulinaemic individuals were classified who showed an increased FAI without the presence of PFOs. Significant P-values were found to be between < 0.05 and < 0.0001. Conclusion: An essential paradigm shift in the diagnosis of androgenized females was presented using an exactly predefined classification of a manageable number of distinguishable FA-entities. An exactly repeatable diagnostic stratification is essential in order to guide customized treatment options by identifying patients’ individual dysfunctions and disorders and by improving their risk assessment. Such an approach may also improve the scientific methodology of clinical studies.