外源性高雄激素血症1例及文献复习

Exogenous hyperandrogenemia:a case report and a review of literature

目的分析外源性高雄激素血症的临床特点、诊断和治疗方法,提高临床医生对该疾病的认识,探讨合适剂量氟他胺在治疗外源性高雄激素血症方面的意义。方法回顾性分析了郑州大学人民医院2018年3月15日收治的1例外源性高雄激素血症患者的临床诊治资料,结合相关文献复习,分析外源性高雄激素血症患者临床表现、诊断、鉴别诊断、并发症和治疗方面最新相关研究进展及预后。结果患者,青春期女性,19岁,主因“停经3月余,发现多毛1月”入院。查体见患者唇部毛发旺盛、喉结突出、肩部肌肉发达。结合患者临床表现及性激素检查,诊断为高雄激素血症,不能排除多囊卵巢综合征。给予达英-35经验治疗1月后效果差,后经多方会诊,结合病史及血、尿游离皮质醇、甲状腺激素和肾上腺CT等确诊为外源性高雄激素血症,给予患者口服氟他胺250 mg,1天两次。患者目前多毛症状改善明显,未出现明显不良反应,建议定期随访。结论外源性高雄激素血症的诊断应主要依据患者既往病史并需紧密结合各项辅助检查进行鉴别诊断。低剂量氟他胺降低血清游离睾酮效果明显,不良反应小,治疗外源性高雄激素血症效果较为显著,服药同时可结合患者临床表征采取对应辅助治疗方式以实现个体化治疗,改善预后,提高患者生活质量。

Objective The clinical characteristics,diagnosis and treatment of exogenous hyperandrogenemia were analyzed to improve clinicians'understanding of the disease and to explore the significance of appropriate dose of flutamide in the treatment of exogenous hyperandrogenemia.Methods The clinical data of one patient with exogenous hyperandrogenemia admitted to the people's hospital of zhengzhou university were retrospectively analyzed,and the clinical manifestation,diagnosis,latest treatment progress and prognosis of exogenous hyperandrogenemia were analyzed.Results The patient,an adolescent female,aged 19,complained of menopause for more than 3 months and found hairy for 1 month.The patient had exuberant lip hair,prominent throat and developed shoulder muscles.Combined with the patient's clinical manifestations and sex hormone examination,the patient was diagnosed as hyperandrogenemia,and polycystic ovary syndrome could not be excluded.After 1 month of treatment with Diane-35,the effect was poor.After Multidisciplinary consultation,combined with the medical history and serum free cortisol,urinary free cortisol,thyroid hormone and adrenal CT,the patient was finally diagnosed as Exogenous hyperandrogenemia,patient were given oral flutamide at 250mg Bid.At present,the patient's symptoms of hypertrichosis have been significantly improved without obvious side effects.Regular follow-up is recommended.Conclusion The diagnosis of exogenous hyperandrogenemia should be based on the patient's previous medical history and closely combined with various auxiliary examinations for differential diagnosis.Low dose of flutamine has an obvious effect on reducing serum free testosterone with few side effects,so it is effective in the treatment of exogenous hyperandrogenemia.At the same time,combined with the clinical characteristics of the patients,the corresponding adjuvant therapy can be taken to achieve individual treatment,improve the prognosis and the quality of life of the patients.