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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2026, Vol. 22 ›› Issue (03): 204 -213. doi: 10.3877/cma.j.issn.1673-5250.2026.03.003

Standard·Proposal·Guideline

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   

  1. 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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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)
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