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Mild cutaneous manifestation in two young women with extraordinary hyperandrogenemia.

Chen W, Chen GY, Tsai SJ, Wang PW, Sheu HM, Shen YS, Chen FF

Department of Dermatology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan. wchen@cgmh.org.tw

Hyperandrogenism with hyperandrogenemia should be considered in those with severe acne of sudden onset or conspicuous male-pattern baldness with hairline recession, although the majority of female patients with acne or androgenetic alopecia possess no endocrine disorder. Herein we describe on the contrary 2 young women with primary amenorrhea displaying prominent hyperandrogenemia but subtle cutaneous manifestation. The first one presenting vertical alopecia had an elevated level of serum dehydroepiandrosterone sulfate (>800 microg/dl) and was suspected to be a case of late-onset, non-classical adrenal hyperplasia. The second case with mild acne had a soaring serum level of total testosterone >9,000 ng/dl derived from an androgen-secreting adrenal adenoma overexpressing steroidogenic acute regulatory protein, P450 side-chain cleavage enzyme and aromatase. A careful patient history and a complete physical examination are mandatory in each individual female case with acne or alopecia. The possibility of adrenal tumor should be explored in patients with escalated circulating testosterone.

Published 17 December 2004 in Dermatology, 210(1): 49-52.
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