Hirsutism Research Articles

CLINICO-TRICHOSCOPIC EVALUATION OF HIRSUTISM TREATED WITH INTENSE PULSED LIGHT IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Objective: The objective of this study is to determine the effectiveness of Intense Pulsed Light in treating hirsutism after three sittings, as evaluated through clinical and trichoscopic assessments, in patients attending a tertiary care hospital in Eastern India. Methods: This was a Descriptive Longitudinal study conducted at the Dermatology Outpatient Department (OPD), Government Medical College, Kolkata, from March 2019 to February 2020. The study included 40 cases of Dermatology OPD attendees who complained of hirsutism. Trichoscopy was used to evaluate treatment response. Data were analyzed using Medcalc. Results: Seventy percent had functional while 30% had organic hirsutism; 65% patients had PCOD and 27.5% had idiopathic hirsutism. All the patients had significant improvement with intense pulsed light with regard to terminal-vellus hair ratio and Terminal hair density observed with trichoscopy irrespective of their medical treatment. The mean modified visual analog score was 6.75±1.1209. According to the modified visual analog score, 57.5% had good reduction while the rest had a moderate reduction. Conclusions: The majority had functional hirsutism. Polycystic ovarian disease and idiopathic hirsutism are the most common causes of hirsutism. Intense pulsed light is an effective and safe method of hair removal, regardless of medical treatment, and trichoscopy can be used to evaluate treatment response.

Rapid Characterization of the Functional and Pharmacological Consequences of Cantú Syndrome KATP Channel Mutations in Intact Cells.

Gain-of-function of KATP channels, resulting from mutations in either KCNJ8 (encoding inward rectifier sub-family 6 [Kir6.1]) or ABCC9 (encoding sulphonylurea receptor [SUR2]), cause Cantú syndrome (CS), a channelopathy characterized by excess hair growth, coarse facial appearance, cardiomegaly, and lymphedema. Here, we established a pipeline for rapid analysis of CS mutation consequences in Landing pad HEK 293 cell lines stably expressing wild type (WT) and mutant human Kir6.1 and SUR2B. Thallium-influx and cell membrane potential, reported by fluorescent Tl-sensitive Fluozin-2 and voltage-sensitive bis-(1,3-dibutylbarbituric acid)trimethine oxonol (DiBAC4(3)) dyes, respectively, were used to assess channel activity. In the Tl-influx assay, CS-associated Kir6.1 mutations increased sensitivity to the ATP-sensitive potassium (KATP) channel activator, pinacidil, but there was strikingly little effect of pinacidil for any SUR2B mutations, reflecting unexpected differences in the molecular mechanisms of Kir6.1 versus SUR2B mutations. Compared with the Tl-influx assay, the DiBAC4(3) assay presents more significant signal changes in response to subtle KATP channel activity changes, and all CS mutants (both Kir6.1 and SUR2B), but not WT channels, caused marked hyperpolarization, demonstrating that all mutants were activated under ambient conditions in intact cells. Most SUR2 CS mutations were markedly inhibited by <100 nM glibenclamide, but sensitivity to inhibition by glibenclamide, repaglinide, and PNU37883A was markedly reduced for Kir6.1 CS mutations. Understanding functional consequences of mutations can help with disease diagnosis and treatment. The analysis pipeline we have developed has the potential to rapidly identify mutational consequences, aiding future CS diagnosis, drug discovery, and individualization of treatment. SIGNIFICANCE STATEMENT: We have developed new fluorescence-based assays of channel activities and drug sensitivities of Cantú syndrome (CS) mutations in human Kir6.1/SUR2B-dependent KATP channels, showing that Kir6.1 mutations increase sensitivity to potassium channel openers, while SUR2B mutations markedly reduce K channel opener (KCO) sensitivity. However, both Kir6.1 and SUR2B CS mutations are both more hyperpolarized than WT cells under basal conditions, confirming pathophysiologically relevant gain-of-function, validating DiBAC4(3) fluorescence to characterize hyperpolarization induced by KATP channel activity under basal, non KCO-activated conditions.

Hyperandrogenism and Its Possible Effects on Endometrial Receptivity: A Review.

Endometrial receptivity is a state of the endometrium defined by its readiness for embryo implantation. When the receptivity of the endometrium is impaired due to hyperandrogenism or androgen excess, this condition can lead to pregnancy loss or infertility. Hyperandrogenism encompasses a wide range of clinical manifestations, including polycystic ovary syndrome (PCOS), idiopathic hirsutism, hirsutism and hyperandrogaenemia, non-classical congenital adrenal hyperplasia, hyperandrogenism, insulin resistance, acanthosis nigricans (HAIR-AN), ovarian or adrenal androgen-secreting neoplasms, Cushing's syndrome, and hyperprolactinaemia. Recurrent miscarriages have been shown to be closely related to elevated testosterone levels, which alter the endometrial milieu so that it is less favourable for embryo implantation. There are mechanisms for endometrial receptivity that are affected by excess androgen. The HOXA gene, aVβ3 integrin, CDK signalling pathway, MECA-79, and MAGEA-11 were the genes and proteins affect endometrial receptivity in the presence of a hyperandrogenic state. In this review, we would like to explore the other manifestations of androgen excess focusing on causes other than PCOS and learn possible mechanisms of endometrial receptivity behind androgen excess leading to pregnancy loss or infertility.

Association of free testosterone, glucose level and obesity among women with polycystic ovary syndrome in Soran city, Kurdistan-Iraq

BackgroundPolycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting approximately 5–10% of women of reproductive age and it is also a major cause of anovulatory infertility. PCOS is associated with obesity and conditions like hirsutism, acne, diabetes, and irregular periods. AimThe present study aimed to evaluate the serum-free testosterone (FT) levels of women afflicted with hirsutism, one of the main physical manifestations of PCOS versus healthy women and determine whether their serum testosterone levels correlate with polycystic ovaries, glucose levels, menstrual abnormalities, and obesity. MethodsThis study assessed 180 women; this included 140 females who suffered from excessive and unwanted hair growth on the chin and 40 healthy women as a control group. Free testosterone levels and fasting blood glucose levels were taken. Prior to the study, ultrasonographic (US) tests were performed for all patients to diagnose polycystic ovaries. ResultsPatients with hirsutism exhibited a significant elevation in free testosterone (FT) compared to the control group. Approximately half of these women were confirmed to have a polycystic ovary, and 42.8% of them were overweight and obese. Additionally, women between 18 and 20 years old (G1) present with the highest level of FT. ConclusionSerum FT levels were significantly increased in hirsute women, and this positively correlated with BMI and glucose levels in women with PCOS. Glucose levels may serve as a potentially effective biomarker in evaluating the severity of hirsutism in women suspected of having PCOS.

A REVIEW AND CURRENT SITUATION OF PCOS WITH INFERTILITY

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens. PCOS causes an imbalance of androgen hormones and causes many of the symptoms of the disorder. It affects about 8-10% of all women of reproductive age and 22% in India. If lifestyle changes are not successful in controlling the symptoms of PCOS, then women may be advised to consider weight loss surgery.In some cases, the weight loss surgery may be combined with hormonal therapy.This treatment aims to achieve even greater weight loss, which may lead to the reduction of excessive facial and body hair. Too much testosterone can also interfere with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation (the release of a mature egg). Hypothyroidism (low thyroid function) is common in women with PCOS. Excess androgens can be induced by insulin resistance and hyperinsulinemia, as they cause a reduction in sex hormone binding globulin levels, which lead to a subsequent increase in free androgens and unfavourable metabolic profiles. The ovarian PCOS morphological traits of enlarged, multi-cystic ovaries and theca interstitial hyperplasia are reported in women who are subjected to high levels of androgens as a result of endogenous adrenal androgen hyper secretion in congenital adrenal hyperplasia treatment in female-to-male transsexuals. Even if an egg is released, the uterus lining or the endometrial may not be ready for pregnancy Symptoms of PCOS The following symptoms will help you understand PCOS occurrence: Irregularity in menstrual cycles or lack of cycles Excessive body or facial hair is seen in teens and females in their 20s The condition worsens over the years with an increase in hair growth It is due to the surplus testosterone and androstenedione that results in high male hormone production in females in their blood. Reproductive age, approx 10% of women are affected by this syndrome, with common symptoms including weight gain, irregular periods, acne, an increase in body hair, and infertility due to ovulation failure.

P-597 Sexual function in women with Polycystic Ovary Syndrome: an updated systematic review and meta-analysis

Abstract Study question To present a comprehensive review of the evidence on sexual function in women with polycystic ovary syndrome (PCOS) compared to women without PCOS. Summary answer Women with PCOS report lower sexual function and sexual satisfaction compared to women without PCOS. What is known already Research focusing on the psychosocial aspects of PCOS or sexual function is fairly recent and data are limited. Data are often contradicting with studies reporting no differences in sexual function in women with PCOS and studies reporting more sexual problems in women with PCOS. A meta-analysis from our group in 2018 reported lower sexual function and lower sexual satisfaction in women with PCOS compared to women without PCOS. Study design, size, duration A systematic review and meta-analysis of the published literature was conducted. Participants/materials, setting, methods Eight databases were searched from inception to August 24th 2022. Two authors independently screened articles based on pre-defined inclusion (e.g. adequate PCOS diagnosis) and exclusion criteria (e.g. hyperandrogenism caused by other diseases),assessed their quality and graded the certainty of the evidence. Review Manager was used to perform all analyses. Main results and the role of chance Twenty-seven articles were included, of which 23 used questionnaires and four used visual analogue scales (VAS). Pooling FSFI scores showed worse sexual function across most domains in women with PCOS, including arousal (weighted mean difference [WMD]== -0.37, P= 0.002), lubrication (WMD= -0.53, P &amp;lt;0.001), and orgasm (WMD= -0.32, P &amp;lt;0.001). Total sexual function (WMD= -2.47, P &amp;lt;0.001) and sexual satisfaction (WMD= -0.42, P &amp;lt;0.001) were also significantly lower. Selection on fertility status did not change the direction of results. VAS results were not pooled in meta-analysis due to using the same control group across the included studies. However, effects within individual VAS studies demonstrated the negative impact of excess body hair on sexuality, lower sexual attractiveness and lower sexual satisfaction in women with PCOS compared with controls, with no differences in the perceived importance of a satisfying sex life. Certainty of evidence was graded low for all included studies. Conclusion: Women with PCOS place similar importance on sexual satisfaction as women without PCOS, yet have lower sexual function and sexual satisfaction. Distress was not assessed. Sexual function assessment, and, psychosexual counseling should be considered as part of standard care in women with PCOS. Limitations, reasons for caution Sexual distress was not assessed. Hence, prevalence of sexual dysfunction which requires both lower sexual function and sexual distress, remains unkown. Certainty of evidence was graded low for all included studies. Wider implications of the findings Sexual function assessment, and, psychosexual counseling should be considered as part of standard care in women with PCOS. Findings from this review have directly informed the international PCOS guideline on sexual function assessment and management. Trial registration number NA

Signalling by senescent melanocytes hyperactivates hair growth

Niche signals maintain stem cells in a prolonged quiescence or transiently activate them for proper regeneration1. Altering balanced niche signalling can lead to regenerative disorders. Melanocytic skin nevi in human often display excessive hair growth, suggesting hair stem cell hyperactivity. Here, using genetic mouse models of nevi2,3, we show that dermal clusters of senescent melanocytes drive epithelial hair stem cells to exit quiescence and change their transcriptome and composition, potently enhancing hair renewal. Nevus melanocytes activate a distinct secretome, enriched for signalling factors. Osteopontin, the leading nevus signalling factor, is both necessary and sufficient to induce hair growth. Injection of osteopontin or its genetic overexpression is sufficient to induce robust hair growth in mice, whereas germline and conditional deletions of either osteopontin or CD44, its cognate receptor on epithelial hair cells, rescue enhanced hair growth induced by dermal nevus melanocytes. Osteopontin is overexpressed in human hairy nevi, and it stimulates new growth of human hair follicles. Although broad accumulation of senescent cells, such as upon ageing or genotoxic stress, is detrimental for the regenerative capacity of tissue4, we show that signalling by senescent cell clusters can potently enhance the activity of adjacent intact stem cells and stimulate tissue renewal. This finding identifies senescent cells and their secretome as an attractive therapeutic target in regenerative disorders.

Survey on lasers used in excessive hair removal and skin revitalization

Lasers are devices commonly utilized in beauty salons for aesthetic treatments. They are most often used for hair removal, scar leveling, hyperpigmentation, skin revitalization, as well as deleting dilated blood vessels and tattoos. The study aimed to analyze the interest of owners of cosmetology and aesthetic medicine salons, as well as their clients, in laser treatments used for excessive hair removal and skin revitalization. The study consisted of an anonymous survey of owners and employees of clinics where aesthetic treatments are performed. The most common laser used is the diode laser, operated by cosmetologists, mainly for excessive hair removal, and less frequently for skin revitalization.

Alexandrite and Nd:YAG Laser vs. IPL in the Management of Facial Hirsutism: A Retrospective Study

Background and objectives: Hirsutism is characterized by the abnormal presence of hair in women, which occurs in typically male areas. The causes of this symptom can be many; however, it is often associated with PCOS. Among the most effective procedures that can be used for hair removal are lasers such as the Alex laser, Nd: YAG, and IPL. Materials and Methods: This study analyzed a total of 71 patients who were treated for hirsutism caused mainly by PCOS; the remaining cases were idiopathic. The patients were divided into two groups: the first group was treated with laser sources, specifically Alex and Nd: YAG, and the second group underwent treatment with IPL. The results were evaluated six months after the last treatment. Results: Out of 71 treated patients, all patients experienced good or excellent hair reduction with greater efficacy in laser-treated patients. The incidence of side effects was low, particularly in the IPL group. Conclusions: Both laser and IPL are efficient, safe, and tolerable procedures in treating PCOS-related and idiopathic facial hirsutism, and both have been shown to have a low rate of side effects. However, the Alex and Nd: YAG lasers guaranteed better hair removal results. A more extensive clinical study will be necessary to confirm our study’s results.

Clinical and paraclinical profile of patients followed for idiopathic hirsutism: About 30 cases

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Do Pleiotropic Effects of Spironolactone in Women with PCOS Make it More than an Anti-androgen? Evidence from a Systematic Review and Meta-analysis.

Spironolactone use as a treatment for hirsutism and other dermatological conditions among polycystic ovary syndrome (PCOS) and idiopathic hirsutism shows varied results. This study thus summarizes the entire evidence to better define its impact on Ferriman-Gallwey (FG) score in addition to other derangements associated with PCOS. PubMed, Embase, Scopus and bibliographies of relevant articles were searched. Randomized controlled trails (RCTs) investigating the efficacy of spironolactone in PCOS and idiopathic hirsutism were included. Pooled mean difference (MD) was calculated using random effects model and relevant subgroup analysis was done. Potential heterogeneity and publication bias was assessed. Of 1041 retrieved studies, 24 RCTs were included. Spironolactone (100 mg/daily) exhibited a significant reduction in FG score in idiopathic hirsutism compared to finasteride (MD: -2.43; 95% C.I: -3.29, -1.57) and cyproterone acetate (MD: -1.18; 95% C.I: -2.10, -0.26), however, no significant difference was found among PCOS subjects in comparison to flutamide and finasteride. A lower dose of spironolactone (50 mg/day) exhibited no significant difference relative to metformin on FG Score (MD: -0.61; 95% C.I: -1.76, 0.54, I2 = 57%), serum total testosterone (MD: -0.61; 95% C.I: -1.76, 0.54), I2 = 57% and HOMA-IR (MD: 1.03; 95% C.I: -1.22, 3.29), I2 = 60% among PCOS women. The main side effects reported by the studies were menstrual irregularity, mild nausea, vomiting and diarrhea. Spironolactone is well tolerated among idiopathic hirsute and PCOS women. The drug significantly improved hirsutism in the former group and shows a positive trend in the latter women, however, displays no effect on FSH, LH, menstrual cyclicity, BMI, and HOMA-IR in PCOS women.

Oral contraceptive pill (OCP) treatment alters the gene expression of intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) in polycystic ovary syndrome (PCOS) women compared to drug-naive PCOS women

BackgroundPolycystic ovary syndrome (PCOS) presents clinical symptoms of menstrual abnormalities, excessive hair growth (hirsutism), scalp hair loss, acne and infertility. Metabolic abnormalities such as obesity, insulin resistance, glucose intolerance and cardiovascular problems constitute an essential part of PCOS, all of which can have significant long-term health consequences. Low-grade chronic inflammation demonstrated by persistent moderately elevated serum levels of inflammatory and coagulatory markers plays a critical role in the pathogenesis of PCOS. Oral contraceptive pills (OCPs) constitute the mainstay of pharmacologic therapy for women with PCOS to regularize cyclicity and ameliorate androgen excess. On the other hand, OCP use is associated with various venous thromboembolic and proinflammatory events in the general population. PCOS women always carriers the increased lifetime risk of these events. The studies on the effect of OCPs on inflammatory, coagulation and metabolic parameters in PCOS are less robust. Therefore in this study, we investigated and compared the messenger RNA (mRNA) expression profiles of genes implicated in inflammatory and coagulation pathways between drug-naive and OCP-treated PCOS women. The selected genes include intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1). Furthermore, the correlation between the selected markers and various metabolic indices in the OCP group has also been explored.MethodThe relative amounts of ICAM-1, TNF-α, MCP-1 and PAI-1 mRNA in peripheral blood mononuclear cells from 25 drug-naive PCOS subjects (controls) and 25 PCOS subjects who received OCPs containing 0.03 mg-ethinyl-estradiol and 0.15 mg-levonorgestrel for at least six months (cases) were estimated using real-time qPCR. The statistical interpretation was conducted using SPSS version 20.0 (SPSS, Inc, Chicago, IL), Epi Info version 2002 (Disease Control and Prevention Centres, Atlanta, GA) and GraphPad Prism 5 (GraphPad Software, La Jolla, CA) software.ResultSix months of OCP therapy enhanced the expression of inflammatory genes viz ICAM-1, TNF-α and MCP-1 mRNA in PCOS women by 2.54, 2.05 and 1.74 folds, respectively, in this study. However, PAI-1 mRNA in the OCP group showed no significant increase. Furthermore, in cases, ICAM-1 mRNA expression positively correlated with body mass index (BMI) (p = 0.01), fasting insulin (p = 0.01), insulin 2 h p = 0.02), glucose 2 h (p = 0.01) and triglycerides (p = 0.01). TNF-α mRNA expression positively correlated with fasting insulin (p = 0.0007). MCP-1 mRNA expression positively correlated with (BMI) (p = 0.002).ConclusionOCPs helped reduce clinical hyperandrogenism and regularise menstrual cycles in women with PCOS. However, OCP use was associated with increased fold expression of inflammatory markers which positively correlated with metabolic abnormalities.

Novel laser hair removal in all skin types.

Laser has been long accepted as a solution for excess or unwanted hair growth yet traditional lasers are not always ideal for safe and effective outcome for all skin types and hair characteristics. A diode laser module combining three wavelengths (755, 810, and 1064 nm) in a single pulse was developed to provide a fast and long-term solution for subjects with various profiles. To evaluate the safety and efficacy of a Triple wavelength diode laser module for hair removal treatment in all skin types (Fitzpatrick I-VI). This was a prospective, dual centered, single-arm study. Subjects were treated with a novel diode laser module. Thirty-six subjects were enrolled, sixteen with Fitzpatrick skin types I-IV (46%) and twenty with Fitzpatrick skin types V-VI (54%). Treatment areas were axilla and bikini lines. Subjects underwent 4 treatment sessions at 6 weeks ± 5 days intervals and attended a follow-up visit 3months after the last treatment session. 2D digital photographs were taken at baseline and at the follow-up visit, and a hair count was conducted by three blinded evaluators. A significant reduction in hair count between baseline and the 3-month follow-up visit was observed in both axilla and bikini lines for all skin types. The mean hair reduction was 41.5± 19.4% and 48.1± 20.9% in the axilla and bikini line, respectively. A significant hair reduction was also observed within skin type groups; mean hair reduction 45.5± 16.9% and 40.3± 17.2% in skin types I-IV and V-VI, respectively, indicating similar efficacy for both light and dark skin types. No serious adverse events were reported. This study demonstrates that the Soprano Titanium laser platform is safe and effective for hair removal treatment in all skin types.

Medicinal plants in nutricosmetics

Nutricosmetics are nutritional supplements that affect the condition of the skin and its appendages. They are available as ampoules, capsules, or tablets which improve skin elasticity and tone, as well as increase its hydration. Supplements, that prevent excessive hair loss and support the proper growth of nails, are also classified as nutricosmetics. Many supplements contain compounds of plant origin that are rich in active ingredients and exhibit a beneficial effect on the physiology of the skin and its appendages. The aim of this study was to assess the health-promoting effects of selected species of medicinal plants used in nutricosmetics based on the latest literature reports. During the analysis of specific species, the herbal raw material, main biologically active substances, their action, and application were taken into account. Active ingredients are obtained from many parts of plants, including fruits, leaves, and herbs. They are a source of flavonoids, mineral salts, vitamins, and antioxidants of antiaging, and anti-inflammatory properties. The wide use of plant raw materials of popular species and the richness of active ingredients of multidimensional action obtained from them, creates great opportunities for the dietary supplement industry.

Androgen-secreting adenoma – a possibility in hyperandrogenism differential diagnosis

Abstract Introduction Hirsutism affects almost 10% of women of reproductive age. The two most common causes of hirsutism are polycystic ovary syndrome (PCOS) and idiopathic hirsutism. Virilizing adrenocortical tumors are rare, nonetheless, it is a differential diagnosis that physicians must consider. Clinical Case We present the case of a 23-year-old woman that was referred from the Dermatology Department due to the abrupt and progressive appearance of hirsutism and facial acne. Her menstrual cycles were regular. She had a BMI of 21.7 kg/m2, facial acne, and a Ferriman-Gallwey scale of 11 points. She did not have hypertension, nor alopecia, clitoris hypertrophy or any other virilizing sign. Table 1 summarizes the analytical determinations requested in the early follicular phase of the menstrual cycle. Pelvic ultrasound scan did not revealed abnormalities. Computed tomography (CT) scan of the abdomen revealed a well-delimited and solid mass of 4.9 × 3.8 cm in the right adrenal gland, with an average density of 48 UH with enhancement on the portal phase without the presence of fat, hemorrhage or calcifications suggesting malignancy more likely (Figure 1). After multidisciplinary assessment, laparoscopic right adrenalectomy was advised. Pathology revealed an adrenal cortex adenoma which showed cytoplasmic immunoreactivity of the cells against inhibin and Melan-A with a KI-67 of 1%, negative for anti-p53 without atypical mitotic figures, necrosis, venous invasion, sinusoidal invasion nor capsular invasion. The post-surgical evolution was satisfactory with an early normalization of androgens and resolution of the virilizing signs. The most common cause of hirsutism in premenopausal women is PCOS; another cause, and far from the first, is the non-classical form of congenital adrenal hyperplasia; and even more uncommon, androgen-secreting ovarian and adrenal tumours (1,2). Adrenal tumours, unlike ovarian, usually secrete DHEAS. Most tumours are carcinomas, which commonly also secrete cortisol (3). A very high DHEAS level (&amp;gt;7 µg/mL) is suggestive of adrenal carcinoma. Pure virilizing adrenal tumours are extremely rare (4). Independently from hormone secretion, the suspicion of malignancy depends on radiological CT characteristics of the tumour: size (&amp;gt;4–6 cm), density (&amp;gt;10 HU with slow contrast washout), homogeneity, and shape (5). Magnetic resonance may assess local invasion (6). Adrenalectomy is the treatment of choice when virilizing adrenal tumours with malignant characteristics are found (7). In the surgical piece, it is useful to determine the Ki 67 (carcinomas: &amp;gt;5%) (8). Somatic mutations in the TP53 gene are associated with aggressive phenotypes(9). Conclusion Malignant ovarian and adrenal pathology should be ruled out in the scenario of new-onset hirsutism. Adrenal malignancy is usually related with tumor size, type of hormones secreted, and the velocity of the tumor progression. Exceptionally, benign adrenal tumours are producers of virilizing hormones.

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.

Hirsutism in Jordanian Women

Objectives: The aim of this study was to assess clinical, hormonal profile, and causes of hirsutism in women who had attended the gynecology clinic at king Hussein medical center. Methods: A retrospective study where clinical information were collected from the medical records of 120 hirsute women, including age, age at onset of the symptoms, duration, rapidity of the onset of the symptoms, parity, menstrual cycle history, age of menarche, family history of hirsutism. Hirsutism was determined by the modified Ferriman-Gallwey index. Laboratory tests and ultrasound were done. Results: The mean age at presentation was 24±4.3 .The maximum hirsutism Ferriman Gallwey score was 20 with a range between10-20. Sixty women (50%) had score more than12. The face was the most common site, 67 women had menstrual abnormalities (55.8%) and 46 were obese (body mass index &gt; 25 kg/M2) (38.3%). A positive family history was obtained in 55women (45.8%). Polycystic ovary syndrome was assumed to be the cause of hirsutism in 68 women (56.8%), 4 women had microadenoma (3.3%) and 3 women had hypothyroidism ((2.5%). Conclusion: Polystic ovary syndrome and idiopathic hirsutism, which were evident in about 94% of the studied patients, are the main causes of hirsutism.

Assessment of Health-Related Quality of Life in Patients with Idiopathic Hirsutism Compared to Patients with Polycystic Ovary Syndrome.

Hirsutism affects 5-15% of women of reproductive age. Health-related quality of life (HQOL) is a multidimensional assessment of well-being that considers the physical, social, and emotional aspects associated with a specific disease. The aim of this study is to evaluate HQOL in patients diagnosed with idiopathic hirsutism (IH) and compare it with patients diagnosed with polycystic ovary syndrome (PCOS). This cross-sectional observational study was performed on 183 female individuals, consisting of 51 patients diagnosed with idiopathic hirsutism, 76 patients diagnosed with PCOS, and 56 healthy volunteers. Participants with a history of neuropsychiatric disorders, under 18 and over 45 years of age, during pregnancy and lactation, with any chronic disease that could interfere with diagnostic laboratory tests, and who had previously been treated for IH or PCOS were excluded from the study. Demographic, anthropometric, laboratory, and clinical data on the cases were recorded. The Short Form-36 (SF-36) questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were administered in a face-to-face interview by related authors involved in the study. The mean age, level of education, lifestyle, and marital status of all three groups were similar. There were no significant differences in body mass index (BMI) or waist circumference between the groups. Mean modified Ferriman-Gallwey (mFG) scores were similar in the IH and PCOS groups. In the IH patients, the general health and mental health domains of the SF-36 questionnaire scores were significantly lower than in the control group (p<0.001 and p=0.026, respectively). When the SF-36 questionnaire scores were compared between the IH and PCOS groups, the general health and role emotional domains were significantly lower in the PCOS group (p=0.013 and p<0.001, respectively), and the other domains were similar. All SF-36 questionnaire domains were significantly and negatively correlated with BMI and waist circumference measurements in IH patients. Both BDI and BAI scores were significantly and positively correlated with BMI (r=0.348, p<0.001, and r=0.162, p=0.012, respectively) and waist circumference (r=0.326, p<0.001, and r=0.344, p<0.001, respectively). Six out of eight domains of the SF-36 QOL scores were significantly and negatively correlated with the mFG scores. Patients diagnosed with IH have impaired HQOL, similar to patients diagnosed with PCOS. Improving HQOL should be a goal when deciding on a management approach for hirsutism, which is one of the most common reasons for referral to endocrinology and dermatology outpatient clinics.

Outcome of Limberg Flap Reconstruction in the Management of Pilonidal Sinus Disease: A Retrospective Study

Introduction: Pilonidal Sinus Disease (PSD) is a tract or cavity commonly seen in the sacrococcygeal region, usually containing a tuft of hair. It is mostly observed in drivers who have excessive hair in the natal cleft region. Although several surgical procedures have been described for the management of PSD, none have been universally accepted as the gold standard. Limberg flap reconstruction, following wide excision, offers a tension-free repair using a well-vascularised flap. This technique flattens the natal cleft, avoiding a midline scar and reducing the chance of recurrence. Aim: The aim of this study was to determine the outcomes of Limberg flap reconstruction in sacrococcygeal PSD. Materials and Methods: A retrospective descriptive study was conducted in the Department of General Surgery at M S Ramaiah Medical College, Bangalore, Karnataka, India. The study duration was six years, from January 2011 to January 2017. The study included a total of 40 patients aged between 15-70 years, with Tezel type III sacrococcygeal Pilonidal Disease (PND), who underwent the Limberg flap procedure. Data was collected and analysed from January to June 2021. Outcome measures such as duration of hospital stay, time required to return to work, and procedure-related complications associated with procedure were analysed and entered into an Excel sheet. Results: The mean age of the study participants was 18.02±6.87 years. Out of the 40 patients, 4 (10%) developed complications. Superficial wound infection was observed in 1 (2.5%) patient, which healed within two weeks. Minimal flap necrosis was observed in 2 (5%) patients, who underwent debridement and dressings on an outpatient basis. The wounds healed within three to four weeks. Recurrence was reported in 1 (2.5%) patient. The mean time to return to work was 18.7±4.88 days. Conclusion: Limberg flap reconstruction for sacrococcygeal PSD is a simple technique with a lower complication rate, faster return to normal activity, and a low recurrence rate.

Advance Research on Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition that causes irregular menstrual periods because monthly ovulation is not occurring and levels of androgens (male hormones) are elevated. It is an important cause of female infertility and a precursor for other critical conditions such as obesity, cardiovascular diseases, type - 2 diabetes and endometrial cancer. It has both reproductive and metabolic effects. It is very difficult to diagnose PCOS during the first 2 years following menarche because normal pubertal changes can mimic symptoms of PCOS. These symptoms are anovulatory menstrual cycles, transient multi-follicular ovarian morphology, increased androgen effects and relative insulin resistance. Common clinical features of PCOS include irregular or heavy or no menstrual periods, excess facial and body hair, acne, pain in the pelvis, difficulty to get pregnant and patches of thick, darker, velvety skin. Diagnosis of PCOS is based on any two of the following three findings. They are no ovulation, high androgen levels and ovarian cysts. Cysts may be distinguishable by ultrasonography. PCOS treatment may involve lifestyle modifications such as weight reduction and regular exercise. Birth control pills help to improve the regularity of menstrual periods, excess hair growth and acne. Metformin and anti-androgens may also help. Other typical acne treatments and hair removal techniques may be used for the treatment of PCOS. Weight loss, clomiphene or metformin also helps to improve fertility. The month of September is considered as Polycystic Ovary Syndrome (PCOS) awareness month around the world. It helps to initiate a conversation about this under diagnosed medical condition. Women who have PCOS are at high risk for several serious complications, some of them can be life threatening complications. Early diagnosis and treatment helps to reduce the risk for many of the complications.