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Virilization

By

Ashley B. Grossman

, MD, University of Oxford; Fellow, Green-Templeton College

Last full review/revision Oct 2020| Content last modified Oct 2020
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Virilization is the development of exaggerated masculine characteristics, usually in women, often as a result of the adrenal glands overproducing androgens (male sex steroid hormones such as testosterone).

  • 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 drugs can reduce the excess hormone production.

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

  • Large amounts of androgen pills or injections (anabolic steroids) 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 (including those in polycystic ovary syndrome [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 is often diagnosed in childhood or adolescence and is termed congenital adrenal hyperplasia.

Symptoms

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 female infants with congenital adrenal hyperplasia, the genitals may resemble those of infant boys. In children, growth may accelerate. If untreated, the growth plates may close prematurely and short stature may result. Affected boys may experience premature sexual maturation.

Diagnosis

  • 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, a dexamethasone suppression test can help determine whether the problem is an adenoma or adrenal hyperplasia. If the problem is adrenal hyperplasia, giving the drug dexamethasone prevents the adrenal glands from producing androgens. If the problem is an 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

  • Surgical removal of the tumor

  • Sometimes glucocorticoids

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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
CORTEF, SOLU-CORTEF
DELATESTRYL
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