«Gestational Hyperandrogenism»: Clarifying Terminology and Practical Management

This review examines the terminological ambiguity surrounding the concept of «gestational hyperandrogenism» in domestic literature and clinical practice. An increase in androgen levels during pregnancy, driven by hormonal adaptation, involvement of the fetoplacental complex, and altered synthesis of sex hormone-binding globulins in the liver, represents a physiological norm. Consequently, patient management in most cases is limited to active monitoring and does not require medical intervention. A key emphasis is placed on distinguishing between pregestational hyperandrogenism and true gestational hyperandrogenism — a rare pathological condition that first manifests during pregnancy due to causes such as luteoma, theca-lutein cysts, or placental aromatase deficiency, all of which typically resolve spontaneously after delivery. The review outlines a systematic approach to the differential diagnosis of these conditions, which is crucial for determining further management strategy and preventing inappropriate treatment. Incorrect interpretation of laboratory findings and overdiagnosis often lead to the erroneous prescription of glucocorticoids to pregnant women, posing potential risks. The article delineates patient management strategies based on identifying the source of hyperandrogenism and assessing the risk of fetal virilization, with an emphasis on dynamic monitoring. Particular attention is paid to the need for topical diagnosis using imaging techniques, as well as the dynamic assessment of androgen status postpartum. Treatment options for true gestational hyperandrogenism are limited, whereas glucocorticoid therapy is justified only in cases of pregestational hyperandrogenism due to congenital adrenal hyperplasia.