《女性雄激素过多症评估临床实践指南》解读：从机制到临床实践

doi:10.3877/cma.j.issn.1673-5250.2026.03.003

中华妇幼临床医学杂志(电子版) ›› 2026, Vol. 22 ›› Issue (03) : 204 -213. doi: 10.3877/cma.j.issn.1673-5250.2026.03.003

标准·方案·指南

《女性雄激素过多症评估临床实践指南》解读：从机制到临床实践

范祖莉¹^,²^,³, 谭惠文¹^,²^,^†(

), 朱慧莉⁴

¹四川大学华西医院内分泌代谢科，成都　610041
²四川大学华西医院垂体瘤及相关疾病诊疗中心，成都　610041
³宜宾市第二人民医院全科医学科，宜宾　644000
⁴四川大学华西第二医院生殖医学科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041

收稿日期:2026-01-30 修回日期:2026-05-07 出版日期:2026-06-01
通信作者: 谭惠文

Interpretation of the Clinical Practice Guideline for the Evaluation of Androgen Excess in Women: from mechanism to practice

Zuli Fan¹^,²^,³, Huiwen Tan¹^,²^,^†(), Huili Zhu⁴

¹Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
²Pituitary Tumor and Related Diseases Diagnosis and Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
³Department of General Medicine, Second People′s Hospital of Yibin, Yibin 644000, Sichuan Province, China
⁴Department of Reproductive Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Received:2026-01-30 Revised:2026-05-07 Published:2026-06-01
Corresponding author: Huiwen Tan
Supported by:
Key Research and Development Program of Science and Technology Department of Sichuan Province(2023YFS0259)

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引用本文：

范祖莉, 谭惠文, 朱慧莉. 《女性雄激素过多症评估临床实践指南》解读：从机制到临床实践[J/OL]. 中华妇幼临床医学杂志(电子版), 2026, 22(03): 204-213.

Zuli Fan, Huiwen Tan, Huili Zhu. Interpretation of the Clinical Practice Guideline for the Evaluation of Androgen Excess in Women: from mechanism to practice[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(03): 204-213.

女性高雄激素血症(HA)是指血清雄激素水平异常升高的一种病理状态，患者常表现为痤疮、多毛、月经稀发或闭经等症状，并可能影响患者生育功能。2025年6月，英国内分泌学会(Society for Endocrinology)发布的《女性雄激素过多症评估临床实践指南》(Clinical Practice Guideline for the Evaluation of Androgen Excess in Women)(以下简称为《本指南》)，为女性HA诊疗管理提供了相关建议。《本指南》结合内分泌学、妇产科学、临床生物化学和护理学领域专业知识制定，为临床医师提供独特的HA患者视角。《本指南》基于循证医学证据为女性HA的临床评估、激素检测、促性腺激素释放激素(GnRH)抑制试验、96 h地塞米松抑制试验(DST)和HA患者影像学检查等提供多学科协作团队(MDT)诊疗指导。笔者拟基于《本指南》，聚焦女性雄激素代谢途径与调控机制，女性HA的疾病谱系及临床特征，以及与其他疾病的鉴别诊断、临床评估体系：从女性HA患者病史到影像学检查进行解读，旨在为临床对女性HA患者的规范化诊疗提供参考。

关键词: 雄激素过多症, 多囊卵巢综合征, 循证医学, 肾上腺疾病, 诊断，鉴别, 女(雌)性

Hyperandrogenism (HA) is a pathological condition in which circulating androgen levels are abnormally elevated in women. It commonly presents with acne, hirsutism, oligomenorrhea, or amenorrhea, and may impair reproductive capacity. In June 2025, Society for Endocrinology released the latest Clinical Practice Guideline for the Evaluation of Androgen Excess in Women (hereafter referred to as " the Guideline" ), providing evidence-based recommendations for the evaluation and management of HA in women. The Guideline was initiated by integrating professional knowledge from endocrinology, obstetrics and gynecology, clinical biochemistry, and nursing, offering clinicians a unique perspective on patients with HA. The Guideline based on evidence-based medicine, provides multiple disciplinary team (MDT) diagnostic and therapeutic guidance for the clinical assessment, hormone testing, gonadotropin-releasing hormone (GnRH) suppression test, 96-hour dexamethasone suppression test (DST) and imaging examinations in women with HA. Based on the Guideline, the authors intend to focus on the androgen metabolic pathways and regulatory mechanisms in women, the disease spectrum and clinical features of women with HA, as well as the differential diagnosis from other diseases and the clinical evaluation system: interpreting the entire process from medical history to imaging examinations in women with HA, with the aim of providing a reference for the standardized diagnosis and treatment of women with HA in clinical practice.

Key words: Hyperandrogenism, Polycystic ovary syndrome, Evidence-based medicine, Adrenal gland diseases, Diagnosis, differential, Female

表1 《本指南》推荐对女性HA患者的主要病因鉴别诊断要点

疾病分类	核心血清生化标志物	特征性临床表现	治疗原则
PCOS	睾酮↑，FAI↑，LH/FSH>2	月经稀发、多毛、肥胖	COC、胰岛素增敏剂
SLCT	睾酮>5 nmol/L, AMH↑	男性化、盆腔包块	肿瘤切除术
21-OHD型CAH	17-OHP>30 nmol/L, DHEAS↑	儿童期男性化、骨龄超前	糖皮质激素替代治疗
ACC	DHEAS↑↑，皮质醇↑，低血钾	库欣貌、腹部肿块	肾上腺切除术＋米托坦
SIRS	胰岛素↑↑，SHBG显著降低	黑棘皮征、瘦型肥胖、大型卵巢囊肿	胰岛素增敏剂
PHT	TSH降低，甲状腺素↑↑	畏寒、乏力、体重增加、皮肤干燥	左甲状腺素替代治疗
CS	皮质醇↑↑	满月脸、水牛背、腹型肥胖，皮肤紫纹	肿瘤切除术＋药物治疗(11β-羟化酶抑制剂，如奥唑司他)
Acro	GH↑，IGF-1↑↑	面容改变、手足增大、牙稀疏、女性雄激素过量	手术＋放射治疗＋药物治疗(生长抑素受体配体，如奥曲肽、兰瑞肽、帕瑞肽等)

表1 《本指南》推荐对女性HA患者的主要病因鉴别诊断要点

疾病分类	核心血清生化标志物	特征性临床表现	治疗原则
PCOS	睾酮↑，FAI↑，LH/FSH>2	月经稀发、多毛、肥胖	COC、胰岛素增敏剂
SLCT	睾酮>5 nmol/L, AMH↑	男性化、盆腔包块	肿瘤切除术
21-OHD型CAH	17-OHP>30 nmol/L, DHEAS↑	儿童期男性化、骨龄超前	糖皮质激素替代治疗
ACC	DHEAS↑↑，皮质醇↑，低血钾	库欣貌、腹部肿块	肾上腺切除术＋米托坦
SIRS	胰岛素↑↑，SHBG显著降低	黑棘皮征、瘦型肥胖、大型卵巢囊肿	胰岛素增敏剂
PHT	TSH降低，甲状腺素↑↑	畏寒、乏力、体重增加、皮肤干燥	左甲状腺素替代治疗
CS	皮质醇↑↑	满月脸、水牛背、腹型肥胖，皮肤紫纹	肿瘤切除术＋药物治疗(11β-羟化酶抑制剂，如奥唑司他)
Acro	GH↑，IGF-1↑↑	面容改变、手足增大、牙稀疏、女性雄激素过量	手术＋放射治疗＋药物治疗(生长抑素受体配体，如奥曲肽、兰瑞肽、帕瑞肽等)

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Interpretation of the Clinical Practice Guideline for the Evaluation of Androgen Excess in Women: from mechanism to practice

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Interpretation of the Clinical Practice Guideline for the Evaluation of Androgen Excess in Women: from mechanism to practice