Endocrine Abstracts

Menopause is a state of relative hyperandrogenism resulting from the abrupt fall of estrogen levels due to ovarian senescence and the steady decline of androgen levels with aging. Frank hyperandrogenism, characterized by hyperandrogenemia and clinical hyperandrogenism, in postmenopausal women is most commonly the result of functional causes of hyperandrogenism, which usually pre-exist menopause from early reproductive years, and are aggravated by the physiological changes of menopause. However, less common causes of timorous hyperandrogenism should also be considered. Polycystic ovary syndrome (PCOS) is the most common cause of functional hyperandrogenism in women during reproductive years, while de novo diagnosis of the syndrome after menopause is problematic. Recent evidence suggest that in patients with PCOS the elevated androgen levels of both ovarian and adrenal origin persist after menopause, possibly contributing to significant long-term consequences including higher prevalence of cardiovascular disease and hormone-dependent malignancies. States of insulin resistance and relative concomitant hyperinsulinemia (such as obesity and diabetes mellitus type 2) are frequent in women after menopause, while it is well documented that aberrations of carbohydrate metabolism parameters are associated to hyperandrogenism. Pre-existing steroidogenic deficiencies (most commonly 21-hydroxylase deficiency) may exacerbate hyperandrogenism after menopause and usually present with mild symptomatology. Although relatively rare androgen-secreting neoplasms originating from either the adrenals or the ovaries are potentionally life-threatening causes of androgen excess, while a subset occur more frequently in postmenopausal women. Androgen-producing tumors usually present with abrupt symptoms of hyperandrogenism or even virilization. Other causes of hyperandrogenism after menopause include relatively rare and common endocrinopathies such as Cushing’s syndrome, acromegaly and thyroid disorders as well as the use of specific drugs. The combination of a detailed history, proper clinical assessment and appropriate laboratory and imaging evaluation is required for the accurate differential diagnosis, proper clinical management and prevention of the long-term sequelae of hyperandrogenism after menopause and particularly identify the less common but potentially life threatening disorders.