Vi

ri
li
sm
De
fini
ti
on Di
agno
sis Ma
nage
ment Re
mar
ksi
fan
y

Vi
ri
li
zati
onisaconditi
on Test
o s
terone Ora
lglucoc
ort
ico
idsfo
r
i
nwhichwomende ve
lop hyper
plas
ia
mal
e-patt
ernh ai
r Otheradrenalandrogens
gr
owthando t
her (dehydroe
p i
andros
te r
one Re
mov
alo
ftu
mor
s
masc
uli
nephysic
altrai
ts.[DHEA]a nditss
u l
fate
Glucoco r
tico i
dsa reu se dfo r
[DHEAS],
androst
enedione
) adrena lhyp erp l
as ia, typ ical
ly
oralhydr ocor tisone1 0mgo n
1
7-hydr
oxyp
roge
ste
rone aris
ing, 5mga tmi dday, a nd5
mgi nthel a teaft e rnoo n.
Dexame
thaso
ne Alternatively, de xame th asone
su
ppres
sio
ntest 0.5to1mgo rallyma ybe
Someti
me s givena tbe dt i
me , bu te ven
adreno
corti
cotr
opi
c theses mall dos esmayc a use
hormone(ACTH) si
gn sofCu shin gs yn dr ome ;
sti
mulati
ontest therefo re,th i
sfo rmo f
glucocorti
c oidi sge ne rallyn ot
Adr
enal
imagi
ng recomme nde d. Givin gt he
dosea tbe dt i
mei smo st
Adrenalvi
r i
lismis
appropr i
atei nt er mso f
sus
pectedc lini
call
y,
suppressingACTHs ec ret i
o n
al
thoughmi ldhirsuti
sm
butma yc au sei nso mn i
a .
andviri
li
zat io
nwi th
Cortis
o nea ce tate2 5mg
hypomenorr heaan d
oral
lyo nceada yo r
el
evatedp l
a sma
prednisone5o ro cca siona ll
y
tes
tosteronema yalso
upto1 0mgo r all
yo nc eada y
occ
urinp olycysticovar
y
canbeu sedi ns tead. Slowe r-
syndrome(St ei
n- rel
easeformsof
Leventhalsyndrome)
. hydroco
rti
soneareal
so
Adrenalvir
ili
smis avai
labl
eandmayp rovi
de
confir
medbys howi
ng bett
erbioc
h emi
calco
ntrol
.
ele
v at
edlev e
lsofadrenal
androgens.

Ina drenalhyp erplasi

a,
uri
n ary
dehydr oepiandr oste
rone
(DHEA)an di tss ul
fate
(DHEAS)ar ee l
evated,
pregn anetriol(a
me tabol
iteo f1 7-
hydr ox
yp roge ster
o ne)
excretioniso ften
i
n creased,a ndu ri
na r
y
freec ortis
o lisnormalo r
diminished.Pla smaDHEA,
DHEAS, 17-
hydr ox
yp roge ster
o ne,
testosterone ,and
andr os
tene dionemaybe
elevated.A1 7-
hydr ox
yp roge ster
o ne
l
e velof>3 0n mo l
/L( 100
0
ng/dL)3 0mi nutesaft er
admi ni
strat i
ono f
cosyntropin( synthetic
ACTH)0 .
25mgI M
str
onglysugge s
tst he
mostcommo nfo rmo f
adrenalhyperpl
asia,
whic
his21 -hydroxyl
ase
defi
cienc
y.

Vi
r i
li
zingt umorsare
excl
udedi f
dexamet hasone0.5mg
oral
lyev e
r y6h oursfor
48h o
urss uppresses
producti
ono fe xces
s
androgens .
Ife xces
sive
androgene xcreti
onisnot
suppressed,CTo rMRIo f
theadre nalsand
ul
trasonogr ap
h yoft h
e
ovari
esa redo netosearch
forat umo r.