绝经后女性高雄激素血症1例并文献复习

Hyperandrogenism in postmenopausal women:a case report and literature review

患者女性,71岁。自绝经10年后逐渐出现多毛症、脱发、阴蒂肥大,曾多次查血总睾酮水平升高(1.55~1.79 ng/mL,正常范围为0.08~0.60 ng/mL),硫酸脱氢表雄酮不高,影像学未见肾上腺及卵巢占位,考虑到患者高龄且合并多种代谢并发症,腹腔镜探查手术风险高,试用促性腺激素释放激素类似物曲普瑞林治疗。32周后,患者毛发变软、脱落,监测黄体生成素从31 IU/L降至0.2 IU/L,睾酮回落至正常(0.47 ng/mL),复查影像学未见肿瘤转移或卵巢增大征象。同时,联合生活方式干预以及降脂治疗,可改善患者代谢异常、减轻心理焦虑,提高生活质量。

A 71-year-old female complained of hirsutism,androgenetic alopecia and enlarged clitoris after 10 years of post-menopause.Laboratory examination of total testosterone level was elevated(1.55-1.79 ng/mL,reference range:0.08-0.60 ng/mL),while dehydroepiandrosterone sulfate was within normal range.No obvious adrenal or ovarian mass was shown on imaging.Laparoscopy exploration was refused owing to advanced age and multiple comorbidities.After the 8-month trial of gonadotropin-releasing hormone analogue triptorelin,improved hirsutism and reduced androgenetic alopecia were observed,with decreased luteinizing hormone levels from 31 to 0.2 IU/L and normalized testosterone levels to 0.47 ng/mL.No signs of tumor metastasis or ovarian enlargement were found on imaging examination.At the same time,the combination of lifestyle intervention and lipid lowering treatment can improve patients'metabolic abnormalities,alleviate psychological anxiety,and improve their quality of life.