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Definition:
Exaggerated development of male secondary sexual characteristics in females or prepubertal boys.
Usually due to excess androgen production from adrenal or ovarian sources.
Can present at any age:
Infancy: ambiguous genitalia
Puberty: premature virilisation
Adulthood: rapid masculinisation
Epidemiology:
Rare condition.
More noticeable in females due to contrast with expected sexual characteristics.
May signal serious underlying pathology — e.g., androgen-secreting tumors, congenital adrenal hyperplasia (CAH).
Occurs globally, with variable prevalence depending on cause.
Key causes of virilism include
| Cause | Clinical clues / notes | Key investigations & comments |
|---|---|---|
| Polycystic ovary syndrome (PCOS) | Most common cause of mild–moderate hyperandrogenism; irregular/absent menses; polycystic ovaries on US; usually causes hirsutism > virilisation | LH/FSH ratio (>3 suggests PCOS), fasting glucose, insulin, lipid profile. Sudden virilisation → investigate other causes |
| Congenital adrenal hyperplasia (CAH) (21-hydroxylase deficiency, classic or non-classic) | Virilisation at birth or puberty; accelerated growth, early pubarche, clitoromegaly | Early-AM 17-hydroxyprogesterone (>300 ng/dL → ACTH stimulation test). Treat with glucocorticoids; refer to endocrinology |
| Androgen-secreting ovarian tumour | Rapid virilisation; deep voice, clitoromegaly; often unilateral | ↑ Serum total testosterone (>200 ng/mL), DHEA-S normal. Pelvic US/CT; surgical removal (oophorectomy) |
| Androgen-secreting adrenal tumour | Sudden virilisation ± Cushingoid features; may cause HTN, hypokalaemia | ↑↑ DHEA-S (>700 µg/dL). CT/MRI adrenal;... |
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