Chapter 179 Virilization
INTRODUCTION
Description: Virilization refers to the loss of female sexual characteristics such as body contour and the acquisition of masculine qualities such as increased muscle mass, temporal balding, deepening of the voice, and clitoromegaly.
ETIOLOGY AND PATHOGENESIS
Causes: Idiopathic ovarian (polycystic ovary syndrome, hilus cell hyperplasia/tumor, arrhenoblastoma, adrenal rest), adrenal (congenital adrenal hyperplasia [10% to 15% of women with hirsutism], Cushing disease, virilizing carcinoma or adenoma), drugs (minoxidil, androgens including danazol [Danocrine], phenytoin, diazoxide), pregnancy (androgen excess of pregnancy, luteoma, or hyperreactio luteinalis).
DIAGNOSTIC APPROACH
Differential Diagnosis
• Cushing’s disease (truncal obesity, facial rounding, cervicodorsal fat deposition [buffalo hump], and red or purple striae are often not fully developed)
Workup and Evaluation
Laboratory: Prolactin, follicle-stimulating hormone (FSH), thyroid screening. Patients suspected of having adrenal sources of hyperandrogenicity may be screened by measuring 24-hour urinary-free cortisol, by performing adrenocorticotropin hormone (ACTH) stimulation tests, or by performing an overnight dexamethasone suppression test. Dehydroepiandrosterone sulfate (DHEA-s) and testosterone should be measured. The circulating testosterone level is generally ≥2 ng/mL.
