Idiopathic hirsutism:Is it really idiopathic or is it misnomer?

Hirsutism,which is characterized by excessive growth of terminal hair in a male pattern,may result from various causes including polycystic ovary syndrome(PCOS),non-classic congenital adrenal hyperplasia,adrenal or ovarian tumors or it may be idiopathic.Idiopathic hirsutism is currently defined as hirsutism associated with normal ovulatory function,normal serum androgen levels and normal ovarian morphology,however,the pathogenesis of idiopathic hirsutism is not clear.The androgens are the main hormones to stimulate growth of body hair,therefore,there should be any form of increased androgen effect irrespective of normal serum androgen levels in any patient with hirsutism.In accordance to this scientific truth,we have previously shown that,although within normal limits,patients with idiopathic hirsutism have relatively higher serum androgen levels(relative hyperandrogenemia)in comparison to healthy subjects which let as to think that is idiopathic hirsutism really idiopathic?In addition to relative hyperandrogenemia,we have previously shown that,in comparison to healthy subjects,women with idiopathic hirsutism demonstrated higher expression of steroid sulphatase and 17-beta hydroxysteroid dehydrogenase mRNA both in the subumbilical region and arm skin,which contributes to local androgen metabolism.Those results support the idea that,in some patients,although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia,pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction.Upon the demonstration of relative hyperandrogenemia and possible increase in local androgen synthesis in patients with idiopathic hirsutism,we think that idiopathic hirsutism is not idiopathic and it may be named as“normoandrogenic hirsutism”.Furthermore,it may not be a different entity but may be an early stage of hyperandrogenic disorders such as PCOS.Clinically,this can be find out by following-up patients with idiopathic hirsutism prospectively.

Clinical, Psycho-Social and Metabolic Profile of Women with Hirsutism in Yaounde

Background: Hirsutism is a clinical situation in Cameroon which is poorly elucidated due to a paucity of clinical and biological data;hence our interest in this study. The aim of this work was to describe the clinical, psycho-social and metabolic profile of women with hirsutism in Yaoundé. Materials and Methods: This was a descriptive cross-sectional study carried out from May 2013 to December 2013. Participants were recruited by announcement through social media. Our study included women at least 18 years old, not in menopausal, not pregnant, not breastfeeding, with hirsutism regardless of severity. They were assessed through an interrogation, anthropometric parameters, a physical examination using the modified Ferriman and Gallwey score, the measurement of fasting capillary blood glucose and a lipid profile. The psycho-social assessment was carried out using a pre-designed questionnaire on the participant’s perception and daily experience with hirsutism. The metabolic syndrome was established according to the criteria of the International Diabetes Federation of 2005 and the National Cholesterol Education Program-third adult treatment panel of 2001. Results: We recruited 60 women aged 27.6 ± 7.0 years. The median Ferriman and Gallwey score was 12. The mean duration of evolution was 9 years. A family history of hirsutism was found in 88.8% of the participants, especially in the mother. Signs of virilization were found in 3.3% of the participants. Association was found between menstrual cycle abnormalities and severity of hirsutism (p = 0.023). Psycho-socially, 58.8% of women found hirsutism normal. The metabolic syndrome was found in 21.7% and 18.3% according to the IDF and NCEP-ATP III, respectively. Conclusion: Hirsutism in our context seems normal to most of our participants. It is, however, associated with menstrual irregularities, signs of virilization and metabolic syndrome. As a result, hirsutism merits further study on a large-scale with emphasis on etiology.

Profile of Female Hyperandrogenism at the Medical Clinic II: About 19 Cases

Introduction: Female hyperandrogenism is essentially manifested by hirsutism. It is present in Senegal but not yet elucidated for lack of data. This is why we proposed to study the profile of hyperandrogenism in our context. Patients and Methods: This was an observational, cross-sectional cohort study of 19 patients of reproductive age followed for hyperandrogenism at the Medical Clinic II of Abass Ndao Hospital, from November 1st, 2019 to August 31st, 2021. Results: Our cohort consisted of women with an average age of 25.3 years, single (73.7%), with a low socioeconomic level (42.1%). A family history of hirsutism was found in 31.6% of cases. The main reasons for consultation were a menstrual cycle disorder in 94.7% of cases, and hirsutism in 78.9% of cases. The latter was post-pubertal (66.7%), with a slow or progressive evolution. The physical examination revealed: hirsutism (100%) with an average modified Ferriman Gallwey score (mFG) of 8.9 ± 5.8, acne (36.8%), hyperseborrhea (57.9%), major signs of virilization (10.5%), acanthosis nigricans (47.4%) and galactorrhea (5.3%). Hormonal explorations revealed an elevation of: testosterone (31.6%), 17-hydroxyprogesterone (5.3%), dihydrotestosterone (31.6%), and prolactin (10.5%). The ovarian morphology was micropolycystic (84.2%). The etiological profile corresponded to polycystic ovarian syndrome or PCOS (68.4%), ovarian hyperthecosis (10.5%), hyperprolactinemia (10.5%), congenital adrenal hyperplasia or CAH (5.3%). Idiopathic hirsutism was found in 5.3% of cases. Conclusion: Female hyperandrogenism is a less frequent reason for consultation in endocrinology. It deserves to be further evaluated in a large-scale study focused on epidemiological, clinico-biological and etiological investigation, in order to assess its prevalence and better define its profile in our context.

Prevalence and characteristics of polycystic ovarian syndrome in a sample of infertile Kurdish women attending IVF infertility center in maternity teaching hospital of Erbil City

Objective: To estimate the prevalence of polycystic ovarian syndrome (PCOS), and to compare the clinical, hormonal and ultrasonography features between infertile women with or without PCOS. Design: A descriptive, comparative study. Materials and Methods: This study was conducted from May 1, 2007 to August 1, 2008, in the Infertility Care and IVF center in Maternity Teaching Hospital, Erbil city, Kurdistan region, North ofIraq. A total of 320 infertile women aged 18 - 45 years, were evaluated for clinical features (oligo-/amenorrhea, hirsutism), body mass index, waist-hip ratio (WHR) and hormonal measures. Transvaginal ultrasonography was used to assess the ovarian morphology. The Rotterdam 2003 criteria adopted by the European Society for Human reproduction and Embryology and the American Society for Reproductive Medicine were used to diagnose cases of PCOS. Data analysis was performed using the SPSS version 15. Results: The prevalence of PCOS was 33%. There were a significant differences between the two groups in terms of oligo-/amenorrhea, hirsutism, WHR, and ovarian ultrasound features. There were no significant differences between the two groups in correlations between the level of obesity with the incidences of anovulation, hyperandrogenemia and hirsutism or with hormonal features. Conclusions: A high prevalence rate of PCOS was observed among infertile women attending IVF center using the Rotterdam 2003 criteria for diagnosis.

Prevalence of Cutaneous Disorders in Patients with Polycystic Ovary Syndrome

Purpose: To determine the prevalence of cutaneous disorders of PCOS and indicate the specific cutaneous lesions that have reliable association with PCOS. Methods: 134 female participants had met the criteria to be diagnosed as PCOS. Dermatological examination regarding hirsutism, acne, androgenic alopecia and acanthosis nigricans as well as any other cutaneous manifestations and assessment of each as regards duration, distribution and scoring was done. Hormonal assay for FSH/LH was done together with ultrasound examination. Results: The study included 134 female participants who had met the criteria to be diagnosed as PCOS; the range of age was 18 - 35 years, with a mean (26.31 ± 4.47 years). Among the PCOS patients at least one cutaneous disorder was found in 18 patients (13.4%), two cutaneous disorders in 44 patients (32.8%), three cutaneous disorders in 47 patients (35.1%), four cutaneous disorders in 24 (17.9%) and five cutaneous disorders were found in only one patient (0.7%). Statistically, there was a significant positive correlations between hirsutism, acne, acanthosis nigricans and LH/F.S.H ratio (p < 0.001), and total testosterone level (p = 0.019, p < 0.001, p < 0.001) respectively. Statistically, there was non-significant difference between patients with and without seborrheic dermatitis regarding LH/F.S.H ratio and total testosterone level (p > 0.5). Conclusions: The current study showed the possible association of hirsutism, acne, acanthosis nigricans, and seborrheic dermatitis with PCOS. These cutaneous manifestations could be relied upon as potential cutaneous indicator of PCOS. Using Rotterdam criteria women who met criteria of PCOS had a higher prevalence of hirsutism, acne, AN, androgenic alopecia and seborrheic dermatitis.

Epidemiological Aspects and Results of the Management of Polycystic Ovary Syndrome at the CNHU-HKM of Cotonou

Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from January 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies including one miscarriage. The occurrence of pregnancy was obtained in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based epidemiological study seems necessary to better appreciate the risk factors of this endocrine syndrome and its repercussions on fertility and metabolic diseases such as type 2 diabetes, obesity and hypertension.

Evaluation of Serum Testosterone, Cholesterol and Plasma Glucose Concentrations in Hirsute Women in Bayelsa State

Hirsutism is an endocrine disorder where women develop excess growth of terminal hairs in a male pattern. This study evaluated the concentrations of cholesterol, glucose and testosterone in bearded women in the Amassoma metropolis of Bayelsa state. In a view to determining whether hirsutism has an effect/relationship with the biochemical parameters estimated, a total of 50 bearded and 50 non-bearded women were recruited for this study. Based on a cross-sectional study, group A and B were appropriately matched for age and BMI. The concentrations of the biochemical parameters were measured using WHO-approved method. Bearded females had significantly higher (p ≤ 0.05) cholesterol concentration (4.41 ± 1.09 mmol/L) when compared with the non-bearded (control) women. Furthermore, the mean concentrations of testosterone and glucose were higher in the bearded female group when compared with the non-bearded. The study established that women with hirsutism have associated hypertestosteronemia, hypercholesterolemia and hyperglycemia.