Androgen excess disorders in women : polycystic ovary by Ricardo Azziz

By Ricardo Azziz

The sector of androgen extra issues has complex considerably because the unique ebook of this ebook. The Androgen extra Society (AES) used to be based to compile investigators within the box. a greater knowing of the screening, development, and molecular genetics of nonclassic adrenal hyperplasia (NCAH) has more advantageous the scientific care and diagnostic accuracy of those sufferers. New standards for the analysis of the polycystic ovary syndrome (PCOS) have been proposed in Rotterdam, standards that experience led to controversy and, optimistically, initiation of recent reviews. The organization of insulin resistance with PCOS has been bolstered, and the function of metformin in tre- ing the infertility of the PCOS has been tested. dangers for diabetes and, extra cont- versially, heart problems in girls with PCOS have acquired sizeable research. Our realizing of the epidemiology and financial influence of those issues has elevated, emphasizing their serious value. those are yet a number of highlights of the way the terrain has replaced in a comparatively short time period. in response to those advances, the name of this publication has been revised to mirror the growing to be value of PCOS because the such a lot regular androgen extra disease in girls, and arguably, because the person who may have the main severe adversarial results for normal wellbeing and fitness. There are fewer chapters to supply a extra targeted elucidation of the realm. a number of chapters have been penned via new (and younger) authors who're carrying out state of the art examine within the box.

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Decreased cortisol production in utero results in a compensatory increase in ACTH, with consequent overstimulation of the adrenal steroid biosynthesis. 17-OHP levels rise in the face of impaired 21hydroxylation and the limited ability of P450c17 to convert 17-OHP to androstenedione. However, continued ACTH-stimulated flux of cholesterol results in accumulation of 17-hydroxypregnenolone, which is then converted to DHEA, androstenedione, and ultimately testosterone, resulting in severe prenatal virilization of female fetuses (41).

This acute regulation is mediated by the steroidogenic acute regulatory protein (StAR), which facilitates the movement of cholesterol into the mitochondrion, where it becomes the substrate for the cholesterol side-chain cleavage enzyme, P450scc, the first steroid biosynthetic enzyme. StAR was first identified as short-lived 30- and 37kDa phosphoproteins rapidly synthesized by steroidogenic cells in response to trophic hormone stimulation (2). Chapter 2 / Adrenal and Ovarian Steroidogenesis 21 The central role of StAR was proven by two observations.

14. Chung B, Matteson KJ, Voutilainen R, Mohandas TK, Miller WL. Human cholesterol side-chain cleavage enzyme, P450scc: cDNA cloning, assignment of the gene to chromosome 15, and expression in the placenta. Proc Natl Acad Sci USA 1986;83:8962–8966. 15. Yang X, Iwamoto K, Wang M, Artwohl J, Mason JI, Pang S. Inherited congenital adrenal hyperplasia in the rabbit is caused by a deletion in the gene encoding cytochrome P450 cholesterol side-chain cleavage enzyme. Endocrinology 1993;132:1977–1982. 16.

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