Virilization is caused by excess production of androgens usually because of a tumor in or enlargement of an adrenal gland or a tumor in an ovary or abnormal hormone production by the ovaries.
Symptoms include excess facial and body hair, baldness, acne, deepening of the voice, increased muscularity, and an increased sex drive.
The body changes make it easy for doctors to recognize virilization, and the dexamethasone suppression test can help doctors determine the cause.
The adrenal gland that contains the tumor is surgically removed, although sometimes medications can reduce the excess hormone production.
(See also Overview of the Adrenal Glands Overview of the Adrenal Glands The body has 2 adrenal glands, one near the top of each kidney. They are endocrine glands, which secrete hormones into the bloodstream. Each adrenal gland has 2 parts. Medulla: The inner part... read more .)
The most common cause of virilization caused by adrenal sex hormones is an
Enlargement of the hormone-producing portions of the adrenal cortex (adrenal hyperplasia)
Other causes include
A hormone-producing tumor (adenoma or cancer) in the adrenal gland
A cancer outside the adrenal gland that produces adrenal androgens or testosterone
Large amounts of androgen pills or injections (anabolic steroids Anabolic Steroids Anabolic steroids are synthetic (man-made) versions of testosterone that are used to increase muscle size. Anabolic steroids are hormones that promote muscle growth and increase strength and... read more ) taken to increase muscle bulk
An abnormality in an enzyme (protein) in the adrenal glands that is present from birth
Cancers outside the adrenal glands that produce androgens are likely to be tumors of the ovaries. Enlargement of the ovaries due to certain types of ovarian cysts Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones (androgens), such as excess body hair and... read more (including those in polycystic ovary syndrome Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones (androgens), such as excess body hair and... read more [PCOS]) may cause virilization, but such cases are almost always mild. Occasionally, overactivity of androgen secretion by the ovaries may occur in later life.
An enzyme abnormality in the adrenal glands leading to increased production of androgens is usually diagnosed in childhood or adolescence and is termed congenital adrenal hyperplasia Congenital adrenal hyperplasia Birth defects of the genitals can involve the penis, scrotum, or testes (testicles) in boys and the vagina and labia in girls. Sometimes the genitals are ambiguous, that is, not clearly female... read more .
Symptoms of Virilization
Symptoms depend on the sex and age of the person affected.
Symptoms of virilization include excess facial and body hair (hirsutism), baldness, acne, deepening of the voice, increased muscularity, and an increased sex drive.
In women, the uterus shrinks, the clitoris enlarges, the breasts become smaller, and normal menstruation stops.
In men, the excess adrenal hormones may suppress the function of the testes and cause infertility.
In infant girls with certain types of congenital adrenal hyperplasia Congenital adrenal hyperplasia Birth defects of the genitals can involve the penis, scrotum, or testes (testicles) in boys and the vagina and labia in girls. Sometimes the genitals are ambiguous, that is, not clearly female... read more , the genitals may resemble those of infant boys. In children, growth may accelerate. If untreated, the growing centers of the bones (growth plates) may close prematurely and short stature may result. Affected boys may experience premature sexual maturation.
Diagnosis of Virilization
Measurement of levels of androgens in the blood
The combination of body changes makes virilization relatively easy for doctors to recognize. Tests can determine the level of androgens in the blood and, if they are high, whether they are likely coming from the sex organs or the adrenal glands.
When the level of adrenal androgens is very high, some doctors use a dexamethasone suppression test to help determine whether the problem is an adenoma or adrenal hyperplasia. If the problem is adrenal hyperplasia, giving the medication dexamethasone prevents the adrenal glands from producing androgens. If the problem is an adrenal adenoma or cancer, dexamethasone reduces androgen production only partially or not at all.
Doctors may do computed tomography (CT) or magnetic resonance imaging (MRI) to obtain a view of the adrenal glands.
Treatment of Virilization
Surgical removal of the tumor
Androgen-producing adenomas and adrenal cancers are usually treated by surgically removing the adrenal gland that contains the tumor.
For adrenal hyperplasia, small amounts of corticosteroids, such as hydrocortisone, generally reduce the production of androgens.