Evaluation of Women With Androgen Disorders

Women who fit into one of these syndromes need to be thoroughly examined to make a specific diagnosis. Initially, full laboratory tests will be drawn to measure the various androgen in the blood. An ultrasound is also done to evaluate the ovaries and the lining of the uterus. It is important to understand that women with these syndromes, if not treated appropriately, are at increased risk to develop pre-malignant and even occasional malignancies in the lining of the uterus.

In addition, you will be brought into the office fasting to measure your insulin levels to determine whether or not there is any degree of insulin resistance.

At the same time, if the baseline tests drawn at the time of your initial visit do not yield definitive answers, a rapid one hour ACTH stimulation test will be carried out. The purpose of this test is to detect abnormalities in the adrenal gland that are not apparent on baseline testing.

The one hour ACTH stimulation test can be thought of as a "stress test" on the adrenal gland. Just as many people with heart disease feel fine if they are sitting down but develop cardiac symptoms when they are put on a treadmill, so too there are many people (both men and women) with androgen disorders that are only apparent if the adrenal gland is "pushed".

The ACTH stimulation test is easy to carry out. Blood is drawn, you are then given an injection of ACTH and additional blood is drawn one hour later. While this is certainly an annoying thing to go through, in the overall scheme of things, it is relatively minor.

Women who have an obvious adrenal abnormality based upon either the baseline testing or following the ACTH stimulation test are treated with adrenal suppression using Prednisone or occasionally Dexamethasone.
Women who do not have an adrenal abnormality are treated with one of several medications, either oral contraceptives or occasionally one of the GnRH agonists.

Women who have evidence of insulin resistance should undergo a 2 hour glucose tolerance test with insulin levels to determine the severity of the problem and to detect a state called "Impaired Glucose Tolerance" - not yet diabetes but on its way. Early intervention may delay or prevent the onset of overt diabetes.