Hyperthecosis, or ovarian hyperthecosis, is
hyperplasia
Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of organic tissue that results from cell proliferatio ...
of the
theca interna
Theca interna cells express receptors for luteinizing hormone (LH) to produce androstenedione, which via a few steps, gives the granulosa the precursor for estrogen manufacturing.
After rupture of the mature ovarian follicle, the theca interna c ...
of the
ovary
The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. ...
. Hyperthecosis occurs when an area of luteinization occurs along with stromal hyperplasia. The luteinized cells produce
androgens
An androgen (from Greek ''andr-'', the stem of the word meaning "man") is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This in ...
, which may lead to
hirsutism
Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin ''hirsutus'' meaning "hairy". It usually refers to a "male" pattern of hair growth in a female that ...
and
virilization
Virilization or masculinization is the biological development of adult male characteristics in young males or females. Most of the changes of virilization are produced by androgens.
Virilization is most commonly used in three medical and biology ...
(or masculinization) in affected women.
The term hyperthecosis refers to the presence of nests of luteinized theca cells in the ovarian stroma due to differentiation of the ovarian interstitial cells into steroidogenically active luteinized stromal cells. These nests or islands of luteinized theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles as in
polycystic ovary syndrome (PCOS). These luteinized theca cells result in greater production of androgens.
Seen as a severe form of PCOS, the clinical features of hyperthecosis are similar to those of PCOS. Women with hyperthecosis often have more markedly elevated testosterone, more hirsutism, and are much more likely to be virilized. While elevated androgens in postmenopausal women is rare, hyperthecosis can present in both premenopausal or postmenopausal women. Women with hyperthecosis may or may not have always had underlying PCOS.
Cause
The etiology of hyperthecosis is unknown, however evidence suggests a possibility of genetic transmission. Hyperthecosis has been documented in familiar patterns.
Insulin resistance
Insulin resistance (IR) is a pathological condition in which cells fail to respond normally to the hormone insulin.
Insulin is a hormone that facilitates the transport of glucose from blood into cells, thereby reducing blood glucose (blood sugar ...
may also play a role in the pathogenesis of hyperthecosis. Women with hyperthecosis have a significant degree of insulin resistance and insulin may stimulate the ovarian stromal androgen synthesis.
Prognosis
Although no large studies showing the long term outcomes for women with hyperthecosis exist, a diagnosis of hyperthecosis may suggest an increased risk for metabolic complications of
hyperlipidemia
Hyperlipidemia is abnormally elevated levels of any or all lipids (fats, cholesterol, or triglycerides) or lipoproteins in the blood. citing: and The term ''hyperlipidemia'' refers to the laboratory finding itself and is also used as an umbre ...
and
type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
. In postmenopausal women, hyperthecosis may also contribute to the pathogenesis of endometrial polyp, endometrial hyperplasia, and endometrioid adenocarcinoma due to the association of hyperestrinism (excess estrins in the body) and hyperthecosis. Treatment for hyperthecosis is based upon each case, but may range from pharmacological interventions to surgical.
See also
*
Polycystic ovary syndrome
Polycystic ovary syndrome, or PCOS, is the most common endocrine disorder in women of reproductive age. The syndrome is named after the characteristic cysts which may form on the ovaries, though it is important to note that this is a sign and no ...
References
External links
{{Gonadal disorder
Metabolism
Sexual anatomy
Physiology