From Big Medical Encyclopedia

VIRILESCENCE (Latin virilis men's, inherent to the man) — an omuzhestvleniye, manifestation (strengthening) of male lines in an organism. The term «masculinization» (Latin of masculinus men's) actually is a synonym, however, despite equivalence of terms, the term «virilescence» is more often used in relation to women's, «masculinization» — to a male body. If the term «virilescence» speaks about development of male lines in general, then the terms «virilny syndrome», «virilism» are used in literature as definition of pathological process in a female body. Occurs under the influence of male sex hormones century — androgens (see) therefore sometimes in the same sense the term «androgenization» is used. Can concern both all organism in general, and its separate parts showing specific sensitivity to influence of androgens century. Tissues of cavernous bodies of a penis and a female clitoris, cartilages of a throat, hair follicles in places of pilosis concern to the last at puberty (a pubis, a stomach, a breast, a face, shins, forearms). Anabolic action of androgens causes strengthening of development of muscles, creating men's type of a figure.

Between the 12th and 20th week of an embryogenesis the embryo to a genetic and gonadal male has fiziol, a masculinization of initially neutral outside genitalias: the vulval shoot of an urogenital sine atrophies, the scrotal seam is closed, the male urethra is formed, cavernous bodies increase and the balanus forms. At a lack of androgens during this period there can be an incomplete masculinization of outside genitalias that is expressed hypospadias (see), underdevelopment of cavernous bodies and balanus, preservation of a vulval shoot of an urogenital sine (picture of an outside men's pseudohermaphroditism). Such patients at the birth are quite often registered a female and they all life socially are women; however it is more correct to characterize the male lines of appearance which are shown at them by the term «masculinization», than «virilescence» because it is about the subject with a genetic and gonadal male (see. Pseudohermaphroditism ).

At an embryo of 12 — 20 weeks with a genetic and gonadal female of V. of outside genitalias can arise at a number of the morbid conditions connected with the increased maintenance of androgens in an organism (e.g., at inborn dysfunction of bark of adrenal glands, the use by mother of androgenic drugs, existence at mother of a virilizuyushchy tumor) as a result of which the false female hermaphroditism forms. According to Wilkins (L. Wilkins), distinguish three degrees of V. of outside genitalias of the newborn girl: The I degree — the disease developed in the second half of the pre-natal period, there is only a hypertrophied and virilized clitoris; at II and III degrees of V. the disease was shown between the 12th and 20th week of embryonal life, and, than earlier, especially V.'s degree of outside genitalias is expressed (the II degree — in addition to increase in a clitoris, is available various depth an urogenital sine, the III degree — full V. of outside genitalias — before formation of a penialny urethra). The pubertal period at patients with inborn dysfunction of bark of adrenal glands chronologically comes before usual. Secondary sexual characteristics develop on men's type, i.e. V. takes all organism of the girl gradually, turning it externally into undersized «man» (due to early closing of epiphyseal regions of growth and the termination of growth of tubular bones of extremities). It is necessary to distinguish a pubertal form of inborn dysfunction of bark of adrenal glands, edges proceeds latentno till the period of pubertal increase in functional activity of adrenal glands. It is very similar to it clinically Matte — Leventalya a syndrome (see), shown at this age, the pathogeny to-rogo is connected with excess products of androgens ovaries. And at a pubertal form of inborn dysfunction of bark of adrenal glands, and at a syndrome of Matte — Leventalya V. is, as a rule, insignificant and is expressed generally in progressing hirsutism (see), sometimes insignificant increase in the sizes of a clitoris against the background of some elements of insufficient feminization (underdevelopment of mammary glands, oppression of menstrual function, a moderate hypoplasia of a uterus).

Androgenoprodutsiruyushchy tumors of bark of adrenal glands (androsteroma) and ovaries (an arrhenoblastoma, a tecoma, lipoidokletochny tumors) can be shown At any age. They never cause II and III degrees of V. of outside genitalias, being delimited by the expressed V. of a clitoris (a penisobrazny clitoris). It can be observed at a number of endocrine diseases century: acromegalias, Itsenko's diseases — Cushing, a diencephalic syndrome, Ashar's syndrome — Tyera, etc.

Emergence of symptoms fiziol, a masculinization at boys at dopubertatny age indicates morbid condition — a syndrome of premature sexual development — macrogenitosomia praecox. Similar pathology was for the first time described by Pellizzi (G. Century of Pellizzi) in 1910 with a tumor of strobiloid gland and therefore occurs at the boy in literature under the name of a syndrome of Pellizzi. Syndrome premature sexual and physical. development (a premature masculinization) of boys has various etiology depending on a source of androgens and the reason of their hyperproduction: androgenoprodutsiruyushchy tumors of bark of adrenal glands (androsteroma), testicles (a seminoma, a leydigoma), inborn dysfunction of bark of adrenal glands, defeat of diencephalohypophysal system with excess allocation of gonadotrophins (see. Gonadotropic hormones ).

Necessary condition for the choice of rational therapy at a virilny syndrome is identification of the reason of a giperandrogeniya, i.e. clarification of a pathogeny and form of a disease. Special diagnostic methods are directed to finding out whether there is primary damage of adrenal glands or ovaries (e.g., at tumors or inborn dysfunction of bark of adrenal glands) or their function is broken for the second time as a result of disturbance of the central regulatory systems. About the general level of androgens in an organism of the patient are guided by amount of testosterone in blood and on excretion with urine 17 of the ketosteroids which are metabolites of androgens. At inborn dysfunction and tumors of bark of adrenal glands excretion of 17 ketosteroids usually considerably exceeds age norm. At ovarian forms of a virilny syndrome even in the presence of tumoral process the level of excretion of 17 ketosteroids happens to urine usually within the upper bound or exceeds norm a little. The following two functional hormonal trials which are consistently applied — test with dexamethasone and test with a gonadotrophin have special diagnostic value. Introduction dexamethasone (see) — glucocorticoid drug — causes decrease in products of AKTG a hypophysis and as a result — reduction of adrenal hormones, reduction of 17 ketosteroids in urine. Test is directed to identification of reduction of secretion of AKTG, level to-rogo in blood regulates secretion of adrenal hormones. Decrease in excretion of 17 ketosteroids by 50% in comparison with initial figures is characteristic of dysfunction of bark of adrenal glands; lack of decrease testifies to a tumor of bark of adrenal glands as hormonal secretion of a tumor is not regulated by AKTG. Also AKTG hyperproduction of androgens at functional disturbances in ovaries is not regulated. For the purpose of recognition of the last against the background of suppression of function of adrenal glands dexamethasone of the patient enter chorionic gonadotrophin (see), stimulating hormonal function of ovaries. At hyper androgenic dysfunction, at a syndrome of Matte — Leventalya, at cerebral forms of anovulatory dysfunction increases excretion of 17 ketosteroids. Tumors of ovaries for the same reasons, as tumors of bark of adrenal glands, do not answer with increase in hormonal products stimulation by gonadotrophins. More indicative data can be obtained if during the conducting test along with a research 17 of ketosteroids to define also excretion of testosterone.

Radiological inspection of adrenal glands in the conditions of contrasting by introduction to pararenal cellulose of oxygen is necessary for differential diagnosis of the diseases which are followed by a virilny syndrome (see. Pneumoretroperitoneum ), what allows to be guided in sizes of adrenal glands and to reveal existence of tumors, and also a pnevmopelvigrafiya (see. Pelvigrafiya ), edges gives the chance to investigate ovaries.

Therapy of a virilny syndrome shall be whenever possible pathogenetic and is directed to treatment of the basic pathological process. At the expressed V. of outside genitalias according to cosmetic indications, and in the presence of an urogenital sine and make operation of feminizing waxed reconstruction of outside genitalias for a possibility of sex life. Cosmetic elimination of virilny pilosis on a face (electroepilation) effectively on condition of removal or oppression of a source of a giperandrogeniya. In certain cases, according to indications, treatment by estrogen for the purpose of strengthening of feminization is applied.

Bibliography: Golubeva I. V., etc. To a question of a virilny form of a syndrome of Matte — Leventalya, Probl, endocrinins, and a gormonoter., t. 16, No. 1, page 6, 1970, bibliogr.; Zhukovsky M. A. Children's endocrinology, M., 1971; Nikolaev O. V. and Kertsman V. I. Kortiko-steroma, M., 1970, bibliogr.; Starkova H. T. Virilny syndrome, M., 1964, bibliogr.; Teter E. Hormonal disturbances at men and women, the lane with polsk., page 466, Warsaw, 1968; At pi of l to and h with L. Diagnosis and treatment of endocrine disturbances at children's and youthful age, the lane with English, M., 1963; Die Intersexuali-tats, hrsg. v. Page of Overzier, Stuttgart, 1961; L a b h a r t A. Klinik der inneren Sekretion, B. u. a., 1971.

I. V. Golubeva.