Prevalence Of Hirsutism Research Articles

073. Tamoxifen - Associated Hirsutism: An Usual Side Effect in A 52-Year-Old Women with Malignant Neoplasm of Left Breast

Background: Hirsutism is a condition characterized by growth of excessive male-pattern (i.e., face, chest, abdomen, lower back, upper arms, and thighs) hair in women. The prevalence of hirsutism has been reported to be between 5% and 15% in women and can be caused by various factors, including the use of medications such as Tamoxifen. The modified Ferriman-Gallwey (mFG) score is the preferred and most widely used method for scoring excess terminal hair in the assessment of hirsutism. This case report aims to explore the relationship between Tamoxifen use and the development of hirsutism, as well as to discuss the potential mechanisms involved. Case: A 52-year-old female patient was diagnosed with a left breast tumor and underwent neoadjuvant chemotherapy followed by treatment with Tamoxifen 10 mg daily for six months. After treatment, the patient reported abnormal hair growth on her face, chest, arms, and legs. Conclusion: The use of Tamoxifen may contribute to the development of hirsutism in some patients. It is important to monitor these side effects and consider appropriate management strategies for patients experiencing hirsutism related to treatment.

THU649 PCOS Phenotype In Unselected Populations (P-PUP) Study: Defining And Comparing Hirsutism Across Various Ethnic Groups In Unselected Populations

Abstract Disclosure: S. Kiconco: None. A.E. Joham: None. L.V. Suturina: None. X. Zhao: None. A. Gambineri: None. F.R. Tehrani: None. B.O. Yildiz: None. J. Kim: None. H.J. Teede: None. R. Azziz: None. Introduction Hirsutism is defined as the male pattern distribution of terminal hair in a female. It is one of the diagnostic features of polycystic ovary syndrome (PCOS), reflecting clinical hyperandrogenism, as measured by the modified Ferriman-Gallwey score (mFG). However, whether the mFG scores and the normative cut-off varies by ethnicity is unclear. We aimed to describe and compare the distribution of mFG score in different ethnic groups from eight countries using data from unselected (medically unbiased) populations to determine and compare the normative cut-off values between the different ethnic groups and the prevalence of hirsutism thereby defined. Methods We utilised data of 10,919 participants aged 15 to 80 years. Data were obtained from epidemiologic studies assessing unselected women conducted in different countries including China, Iran, Italy, Nigeria, Russia, South Korea, Turkey, and the United States of America. The distribution of mFG between ethnic groups was determined descriptively as medians. Cluster analysis (k means, k=2) and the receiver operating characteristics curve were used to determine the normative cut-offs for the mFG score. All medians, cut-offs and percentile values were compared between ethnic groups using the Kruskal-Wallis test at a 95% level of significance. Results Our data consisted of 11 ethnic groups from 8 countries. The Persian (4.8±4.7) and Italian (4.8±4.7) populations had higher median mFG scores than the rest of the ethnic groups, whilst Asian populations (Chinese, Korean and Buryat) had the lowest scores. Overall, the median distribution of mFG differed significantly by ethnicity. Using cluster analysis, the mFG cut offs range from 4 to 9, with the Persian ethnic group having the highest, followed by the Italian group, with cut-offs differing by ethnicity overall; however cut offs are similar for Black American, Turkish, Asian and Russian groups. Conclusion The distribution and normal cut off values for hirsutism differ significantly by ethnicity, with the Persian population having the highest cut offs. Ethnicity needs to be considered when assessing women for clinical hyperandrogenism. Presentation: Thursday, June 15, 2023

SAT380 Clinical, Metabolic And Hormonal Profile In Women Carrying Cyp21a2 Mutations

Abstract Disclosure: S. Livadas: None. D.G. Goulis: None. E. Belardinelli: None. E. Armeni: None. B. Solmi: None. S. veneti: None. I. Lambrinoudaki: None. C. Cecchetti: None. D.P. Macut: None. A. Gambineri: None. Background: Heterozygote (HET) CYP21A2 gene mutations are present in 5-10% of the general Mediterranean population. Despite that homozygotes suffer from classical or non-classical congenital adrenal hyperplasia (NC-CAH), a survival advantage has been suggested for heterozygote carriers. The aim of this study was to describe the clinical, metabolic and hormonal profile in reproductive age women with CYP21A2 HET. Methods: Data from 56 HET women were compared with 105 controls, 64 untreated women with NC-CAH and 63 women with polycystic ovary syndrome (PCOS) of similar age and body mass index. Results: The prevalence of hirsutism (54 vs. 8%) and acne (44 vs. 4%) was higher in HET than controls. The degree of menstrual irregularities was similar between HET and NC-CAH and worse than controls. The lipid profile was better in HET than PCOS (Cholesterol 170.2±37.1 vs. 187. 7±39.3 mg/dl, HDL 61.4±26.1 vs. 46.8±8.6 mg/dl), but similar to NC-CAH. Testosterone (0.78±0.45 vs. 0.50±0.25 ng/dl), SHBG (38.2±20.1 vs. 56.2±31.4 nmol/l), FAI (9.56±3.45 vs. 5.37±1.24) and DHEAS concentrations (2.62±1.31 vs. 1.27±0.94 nmol/l) were similar to HET, NC-CAH and PCOS and significantly higher than controls as well as insulin (13.88±7.96 vs. 7.51±2.82 IU/l) and HOMA-IR (2.95±1.60 vs. 1.65±0.67). Δ4- androstenedione (5.97±2.88 vs. 8.80±3.45 ng/ml) and 17(OH)-progesterone (4.32±2.02 vs. 13.75±8.34 ng/ml) concentrations were lower in HET than in NC-CAH, but higher than PCOS and controls. Finally, ovarian PCO morphology prevalence was similar in HET than NC-CAH and PCOS. Conclusions: HET display a favorable lipidemic profile, but a similar degree of hyperandrogenic signs, menstrual disturbances, insulin resistance, hyperandrogenemia and ovarian morphology than women with PCOS or NC-CAH. Therefore, these women, when identified, should be followed-up. Presentation Date: Saturday, June 17, 2023

Prevalence of hirsutism in obese Tunisian women

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

Clinical profiling of polycystic ovary syndrome patients in Kashmir population

Background: Polycystic ovary syndrome (PCOS) is a major endocrinopathy that affects women during their child-bearing age. PCOS women exhibit excess androgens, irregular or no ovulation, and polycystic ovaries. Objective: The aim of this study was to evaluate the demographic, anthropometric, physical, reproductive, metabolic, endocrine parameters, and ovarian volume (OV) of PCOS women. Materials and Methods: This study was case control including the clinically diagnosed PCOS women (100) and healthy women (100) as controls. Both groups were assessed for the demographic features such as age, anthropometric parameters such as height and weight, physical parameters such as body mass index (BMI), waist-Hip ratio, reproductive parameters such as menarche, and hirsutism (Ferriman Gallwey Score, acne, and alopecia), and the biochemical parameters including blood sugar fasting (BSF), hormone profile (luteinizing hormone [LH], follicle-stimulating hormone [FSH], testosterone, and prolactin), lipid profile (cholesterol, triglycerides, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and very LDL [VLDL]), thyroid-stimulating hormone (TSH) using prestructured questionnaire. The OV was observed by ultrasonography. Results: We observed significantly higher body weight, BMI, waist/hip ratio, reproductive cycle duration, prevalence of hirsutism, LH, FSH, testosterone, prolactin, triglycerides, HDL, LDL levels, and OV in patients compared to controls. However, the average number of cycles per year and VLDL levels were significantly lower in the patient. No significant difference was found in BSF and TSH levels between the patient and control groups. Conclusion: The proper evaluation of the demographic, anthropometric, physical, reproductive, metabolic, endocrine parameters, and OV may help in the accurate diagnosis of PCOS that will benefit the affected women with timely therapy commencement.

Clinical Manifestations of Hyperandrogenism and Ovulatory Dysfunction Are Not Associated with His1058 C/T SNP (rs1799817) Polymorphism of Insulin Receptor Gene Tyrosine Kinase Domain in Kashmiri Women with PCOS.

Background Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder affecting premenopausal women. Besides primary features like anovulation, hyperandrogenism, and polycystic ovaries, women with PCOS present with multiple metabolic, cardiovascular, and psychological disorders. The etiology is multifactorial and the different genetic variants are suggested to play an important role in pathogenesis. Insulin resistance is a ubiquitous finding in PCOS and SNPs in genes involved in the insulin signaling pathway are possible candidates that can explain the development of clinical manifestations of PCOS. Aim We aimed to investigate the association of INSR His1058 C/T (rs1799817) single nucleotide polymorphism with PCOS in Kashmiri women. The genotypic-phenotypic correlation of the tested SNP with hyperandrogenism, ovulatory dysfunction, and metabolic markers was evaluated. Results The allele frequency (OR = 1.00, 95% CI = 0.67–1.48, χ2 = 0.01, P=0.99) and genotype distribution (χ2 = 3.73, P=0.15) in INSR C/T polymorphism were comparable with controls. No significant association was found with PCOS in dominant (P=0.194), recessive (P=0.442), and homo vs. het. (P=0.5) genotype models. Genotype-phenotype correlation analysis revealed that variant TT genotype had significantly higher HOMA (P=0.029) and reduced insulin sensitivity QUICKI (P=0.037) values. There was no significant variation in the prevalence of hirsutism, acne, alopecia, menstrual disturbances, acanthosis nigricans, and obesity (all P > 0.05) in different INSR C/T genotypes. Conclusion The INSR C/T SNP (rs1799817) does not increase the risk of PCOS in Kashmiri women. This SNP is unlikely to play a significant role in the development and manifestation of clinical symptoms of polycystic ovary syndrome.

Prevalence of Hirsutism among Females with Chronic Obstructive Pulmonary Disease and Hyperthyrodism at Tertiary Care Hospital of Sindh, Pakistan

Introduction: Hirsutism is in fact unwanted growth of hairs on the various parts of body of females. Hairs arises particularly on those parts of the body on which hairs are not grown normally in females such as chin, upper lips, abdomen, legs, shoulder and back of the body. Various reasons are reported till so far for the hirsutism development. The prevalence of hirsutism was very low.
 Methodology: Across-sectional study was conducted at tertiary care hospital of Sindh, Pakisan for the period of 06 months. A well structured questionnaire was developed comprises on three parts. Which was given to the female students and all the participants were guided regarding filling of that proforma and Ferriman-Gallway scale was used to measure the frequency parameters of Hirsutism.
 Results: The condition of hirsutism was found among 183 participants, the distribution of hairs was quite different in all selected study subjects. 26 females had hairs on chin, 154 females had hair grown on upper lips, 24 females had hairs on lower abdomen, 13 had hairs on upper abdomen, 11 participants had hairs on arms and legs whereas only 04 girls had hair grown on their shoulders and back of the body. As far as their family background is concern 41 females were belongs to upper class, 117 females belongs to middle class while 25 females were belonging to lower class families.
 Conclusion: The prevalence of hirsutism was very much common among the females with the associated condition of Idiopathic hirsutism (53%), pulmonary chronic obstructive diseases (31.5%) and Acanthosis nigricans was the most widely recognized cutaneous finding related with hirsutism.

The prevalence of hirsutism in overweight and obese females attending obesity research and therapy unit

The prevalence of hirsutism in overweight and obese females attending obesity research and therapy unit

Prevalence of Hirsutism in Turkey: Data of The Dermatoendocrinology Study Group

Prevalence of Hirsutism in Turkey: Data of The Dermatoendocrinology Study Group

Prevalence of hyperandrogenism in Iraqi women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a mainly common endocrine disorder. Hyperandrogenism is the major standard in the diagnosisof PCOS development.Eighty women diagnosed with PCOS and twenty healthy women(aged 20-40 years)were enrolled in this study which was conducted at the infertility clinic of Kamal AL-Samaraay Hospital/ Baghdad. The diagnosis of PCOS was made according to the Rotterdam criteria. Body mass index (BMI, Kg/m2)was calculated by a specific formula. History of menstrual irregularity, hirsutism, acne, and alopecia was taken. Hormone levels in serum, namely luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone were measured in all patients and control subjects.There was a statistically significant difference (P <0.05) in the BMI between the PCOS and control women.Also, the prevalence of overweight and obesity was much higher in PCOS women than in their matching control. The serum levels of LH, FSH, and testosterone were significantly different (P <0.05) in PCOS as compared to healthy women. Clinical hyperandrogenism (hirsutism and alopecia) were present in most of PCOS women, while acne wasa less useful clinical sign of hyperandrogenism.Inaddition, the prevalence of hirsutism and alopecia was increased in obese when compared with overweight and lean PCOS women.

Insulin resistance is associated with hirsutism in unselected reproductive-aged women.

Hirsutism affects 5%-10% of reproductive-aged women worldwide and exhibits clinical importance as a cutaneous manifestation of underlying hyperandrogenism. Racial and genetic factors play roles in manifestation of hirsutism, and the prevalence of hirsutism seems to be low in East Asians. However, the reference value of the modified Ferriman-Gallwey (mFG) score to diagnose hirsutism and the prevalence of hirsutism have not been determined in Korean populations to date. We aimed to investigate the distribution of the mFG score and establish its reference value for defining hirsutism and to examine its relationship with metabolic and reproductive traits in reproductive-aged Korean women. We enrolled 2139 female volunteers of reproductive age (15-39years). We recorded mFG scores from 0 to 4 on 9 different body locations (upper lip, chin, chest, arm, upper abdomen, lower abdomen, upper back, lower back and thighs). Hirsutism was defined as >95th percentile of mFG score. In addition, a 75-g oral glucose tolerance test was performed, and the homoeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The mFG values of the 50th, 75th, 90th and 95th percentiles were 0, 1, 4 and 6, respectively. Therefore, the mFG score was indicative of hirsutism when the score was 6 or greater, which represents the 95th percentile. In the correlation analysis, total testosterone, free testosterone, fasting plasma insulin and HOMA-IR were positively correlated with mFG score (all Ps <0.05). Multiple linear regression analysis revealed that HOMA-IR (β=0.081) was positively associated with mFG score after adjustments for age, body mass index, total testosterone and the number of menses per year (P<0.001). In conclusion, setting the 95th percentile of the mFG score as normal, the reference value to define hirsutism was 6 in reproductive-aged Korean women. HOMA-IR was positively associated with the mFG score even after adjustment for biochemical hyperandrogenism.

Clinical, Biochemical and Hormonal Profile of Polycystic Ovary Syndrome

Background: The polycystic ovary syndrome is a heterogenous condition, the pathophysiology of which is multifactorial. It is considered as a systemic and metabolic disorder like hyperglycemia and insulin resistance with increased risk of type II diabetes mellitus and cardiovascular diseases.Objective: The purpose of the present study was to analyze the clinical, biochemical and hormonal profile of patients PCOS and to find out correlations among them.Methodology: This cross-sectional observational study was done including 100 diagnosed cases of PCOS attending the GOPD, BSMMU Hospital. This study was done to analyze the clinical, biochemical and hormonal characteristics of PCOS patients and to observe the correlations among them.Result: The mean age of study populations was 22.7± 6.9 years and more than half of them were overweight or obese. Menstrual abnormality like oligomenorrhoea and secondary amenorrhoea was found in 95% cases and 5% were eumenorrhic. Prevalence of hirsutism and subfertility was 69% and 50% respectively. More than half (52%) of cases had LH/FSH ratio &gt;2 which is taken to be significant. About one-third (30%) of cases had total testosterone level above the reference range with a mean value of serum testosterone 71.4±27.9 ng/dL.Conclusion: Significant positive correlation was found among increased BMI, increased LH/FSH ratio, serum testosterone and serum TSH level. Further studies are needed to corroborate our findings and to find out the clinical, biochemical and endocrinological characteristics of our women of PCOS.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 94-98

Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study.

Background:Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women, affecting 5–10% of reproductive-aged women. The dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, androgenic alopecia, and acanthosis nigricans, are among the cardinal manifestations of PCOS.Aim:To study the incidence and prevalence of various cutaneous manifestations in patients with PCOS and to correlate these skin manifestations with hormonal changes.Settings and Design:This study was conducted at a dermatology centre over a period of 1 year from November 2012 to 2013.Materials and Methods:The present study included 100 women diagnosed to have PCOS. Hormonal analysis as well as radiological assessment was done in all the cases. Cutaneous manifestations were ascertained and inferences were drawn.Statistical Analysis:Statistical analysis was carried out by the Chi-square test and independent samples t-test. Statistical significance was determined at a level of P < 0.05.Results:In our study, the prevalence of hirsutism, acne, female pattern hair loss, acanthosis nigricans, seborrhea, striae and acrochordons was 78%, 48%, 31%, 30%, 29%, 13%, and 9%, respectively.Conclusion:Dermatologic manifestations of PCOS play a significant role in making the diagnosis and constitute a substantial portion of the symptoms experienced by women with this syndrome.

Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management.

Hirsutism is defined as the presence of terminal hair with male distribution in women, and polycystic ovary syndrome (PCOS) is the most common etiology of hirsutism. The aim of this study is to review aspects of hair growth that are relevant for the understanding of hirsutism in PCOS, along with current treatment alternatives. The prevalence of hirsutism in PCOS ranges from 70 to 80%, vs. 4% to 11% in women in the general population. Hirsutism in PCOS is associated with both ovarianderived androgen excess and individual sensitivity of the pilosebaceous unit to androgens. Interventions to decrease hirsutism in PCOS include the suppression of androgen excess by combined oral contraceptives (OCPs). If OCPs are contraindicated, mainly in the presence of insulin-resistance related comorbidities, a second-line option for reducing androgen secretion may be metformin associated with lifestyle changes. Other interventions should be guided by hirsutism severity, determined by the modified Ferriman-Gallwey score, and by the amount of distress hirsutism causes to the patient, and should be maintained for at least 6-12 months. Mild hirsutism is usually treated with a combination of non-pharmacological methods and OCPs, whereas moderate and severe hirsutism may require a combination of antiandrogens and OCPs, or, if OCPs cannot be used, antiandrogens plus a safe contraceptive method. In all cases, strong clinical support is crucial to ensure treatment adherence and success. The understanding of the pathophysiology of hirsutism in PCOS, as well as classifying its severity and the distress it causes to each patient is essential to choose the proper treatment. The presence of metabolic comorbidities and menstrual disturbances will also guide the individualized management of hirsutism in women with PCOS.

Polycystic Ovarian Syndrome and Hirsutism

Polycystic Ovarian Syndrome(PCOS) affected 5-15% of women and is the commonest cause of hirsutism in women. The prevalence of hirsutism in PCOS patients is 70-80% compared with 4%-11% in women in the general population.Methods: A search in the Medline, Pub Med, Cochrane library database and Embase was made. Prospective randomized trials, systematic reviews,meta-analysis and retrospective studies on hirsutism and PCOS were extracted and reviewed. Evidence for the different outcomes and recommendations for interventions were used on the best available data.Review of Evidence: Evidence revealed that there is no universal agreement on the definition of PCOS. The NIH, ESHRE and ASRM and Androgen Excess and PCOS Society use different definitions based on the three criteria of Oligo anovulation (OA), biochemical or clinical hyperandrogenamia (HA) and polycystic ovarian morphology (PCOM). Moleular pathways modulating androgen biosynthesis and their relationship to insulin metabolism have enhanced our understanding of the pathophysiology of PCOS and its therapy. Hirsutism in PCOS is due to excess production of ovarian androgen driven by high level of LH.Life style modification and loss of body weight in PCOS patient complaining of hirsutism should be advised. Effective medical treatment includes, combined hormonal contraceptives (CHCs), antiandrogens or combined CHCs and antiandrogens. Insulin sentizers are also useful when there is associated hyperinsulinaemia.Short term and long term effective methods for treatment of hirsutism are also available and effective.Conclusion: The strategy for management of PCOS patients with hirsutism should be patient centered. Medical treatment and cosmetic treatment are effective. Long term sequela of PCOS should not be overlooked..

Prevalence and patterns of hirsutism among Sri Lankan females

Objectives: In order to describe the prevalence of hirsutism in young female population of Sri Lanka, we studied a group of young females to determine the pattern of body hair distribution and grade it according to the modified Ferriman-Gallwey score (mFG). Method: A descriptive cross sectional study was conducted in the year 2000 with eighty-five female medical students who entered the Sri Jayawardenapura University that year. After consent, each subject was interviewed by a medical officer and an interviewer-administered questionnaire was utilized. The body hair distribution was recorded using the mFG score. Results: Age of the study population ranged from 21 to 24 years. None of them have used steroids or psoralens prior to study. Only 3 (3.5%) had menstrual irregularity. The mode, Mean and the Median of the total MFG score were 5.0, 8.9 and 9.0 (IQR- 5 to 11) respectively. The prevalence of hirsutism was 56.5% (CI from 45.96 to 67.04) among the study population. Lower limb score had the highest mean value of 1.80 while Lip score had the lowest mean value of 0.31. All the 09 variables had statistically significant correlations with the total score while ‘‘lower abdomen score’’ had the strongest correlation of 0.82. Conclusion: The prevalence of hirsutism among this young female population was relatively high (56.5%). They were seen to have a high degree of hair growth in all the areas tested on mFG score. The lower abdominal area had the strongest correlation with the mFG score. As many factors including genetic predisposition determine hirsutism this has to be considered when evaluation of young females for hirsutism. Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2015; 5: 51-55

The gonadal effects of diabetes

The functional reproductive alterations seen in women with type 1 diabetes (T1D) have changed as therapy has improved. Historically, patients with T1D and insufficient metabolic control exhibited a high prevalence of amenorrhea, hypogonadism, and infertility. Recent publications have shown that in spite of intensive insulin therapy, some delay in the age of thelarche, pubarche and menarche is still observed in girls with T1D. In addition, ovarian hyperandrogenism may be observed during late adolescence and an increased prevalence of hirsutism and polycystic ovarian syndrome (PCOS) has been described in adult women with T1D. These endocrine abnormalities may be related to non-physiologic insulin replacement therapy and to hyperglycemia. Insulin is well known for its effects on carbohydrate metabolism, but this hormone also plays an important role in regulating ovarian function. Granulosa, theca and stromal ovarian cells may be affected by insulin deficiency or excess, which may be present in women with type 1 diabetes mellitus (T1D)[1]. Diabetes disrupts hypothalamic-pituitary-ovarian function, as documented by animal model studies which have helped to decipher the underlying basis of these conditions and have highlighted the variable contributions of defective leptin, insulin and kisspeptin signalling to the mechanisms of perturbed reproduction in T1D[2]. Effects of diabetes on gonadal function vary according to the age of the patient. Young girls during adrenarche exhibit an elevation of DHEAS, androstenedione, inhibin B and anti-mullerian hormone[3], an endocrine profile that is similar to the one observed in young girls in risk of developing polycystic ovarian syndrome later in life. During puberty a delay in pubertal development has been described which is followed by menstrual irregularities and hyperandrogenism during adolescence [1,4,5]. Despite these abnormalities in ovarian function, ovulatory functions is preserved in adolescents with type 1 diabetes[6]. Later in life, adult women with type 1 diabetes exhibit PCOS, polycystic ovaries at the ultrasonographic exam, menstrual irregularities and early decline in ovarian reserve[7-9]. Clearly, despite improvements in insulin therapy, T1D patients still suffer several significant clinical problems, such as pubertal delay, menstrual disturbances and hyperandrogenism which may ultimately lead to the development of PCOS in adulthood. (Fondecyt 1100123 y 1050452)

Changes in the PCOS phenotype with age

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-age women. The diagnosis of PCOS is mainly based on the following three components: (1) hyperandrogenism, (2) oligo-amenorrhea, and (3) the observation of polycystic ovaries on a sonogram. The comorbidities may include insulin resistance, type II diabetes mellitus, hypertension and cardiovascular disease. Importantly, the diagnostic criteria and complications related to PCOS are age-dependent. Androgen production in women may decrease because of ovarian aging or decreased production by the adrenal glands over time. The prevalence of hirsutism and acne decreases with age. Ovarian volume and follicle number also decrease with age, with the age-related decrease in follicle number seemingly greater than that of ovarian volume. Aging may also be associated with increased risk of insulin resistance and metabolic disturbances. Therefore, these age-related changes may affect the observed incidence and complications of PCOS. In adolescent patients, the criteria described above pose particular diagnostic problems because the characteristics of normal puberty often overlap with the signs and symptoms of PCOS. Hyperandrogenism and chronic anovulation are the primary disturbances in younger women with PCOS; whereas, obesity, insulin resistance, and metabolic disturbances are predominant in older women with PCOS. The deterioration of insulin resistance during the reproductive life of women with PCOS appears to be mainly attributable to the increase in obesity. Therefore, if body weight could be controlled properly, younger hyperandrogenic PCOS women might reduce their risk of insulin resistance and metabolic disturbances later in life.

Clinical and Metabolic Features of Polycystic Ovary Syndrome among Chinese Adolescents

ObjectivesTo explore the clinical and metabolic features exhibited by Chinese adolescents with polycystic ovary syndrome (PCOS) and to determine the differences between nonobese and obese adolescent patients with PCOS. DesignClinical cross-sectional study. SettingDepartment of Gynecology and Reproductive Center. Participants25 obese and 66 nonobese adolescents with PCOS and 26 age-matched controls. InterventionsFasting venous blood samples and an oral glucose tolerance test using 75 g of glucose were obtained from PCOS patients and controls. Main Outcome MeasuresClinical features were summarized. Serum levels of FSH, LH, E2, TT, SHBG, fasting insulin, and fasting glucose were measured. ResultsThe prevalence of obesity in adolescents with PCOS was 27% (25/91). 99% of these patients presented with menstrual disorders, 84% presented with clinical and/or biochemical hyperandrogenism, and 90% exhibited an ultrasonographic appearance of polycystic ovaries. The prevalence of hirsutism and acanthosis nigricans were higher in the obese PCOS group than in the nonobese PCOS group (72% vs 41% and 44% vs 5%, respectively). A total of 5 of 20 obese (25%) and 5 of 36 nonobese patients (14%) demonstrated impaired glucose tolerance levels. ConclusionsChinese adolescents with PCOS manifest clinical and metabolic features similar to those of adult Chinese women with PCOS except for the increased prevalence of hyperandrogenism and insulin resistance. Adolescents with high risk factors, especially those with menstrual disorders and hyperandrogenism, may need careful clinical screening.

High prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus despite different hormonal profiles

To compare the pubertal development, the hormonal profiles and the prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus (T1DM). Data were collected from 96 obese adolescent girls and 78 adolescent girls with T1DM at Tanner stage IV or V, whose ages ranged between 11.9 and 17.9 years. High prevalence of hirsutism and menstrual disorder was found in the obese adolescent girls (36.5 and 42% respectively) and the adolescent girls with T1DM (21 and 44% respectively). The obese girls were significantly younger at pubarche, thelarche and menarche than the girls with T1DM. Hirsutism in the obese girls and those with T1DM was associated with hyperandrogenaemia and a raised free androgen index (FAI). When the cause of the raised FAI was investigated in both the groups of girls with hirsutism, the raised FAI in the obese girls was due to low serum sex hormone-binding globulin (SHBG) levels. In contrast, the raised FAI of the girls with T1DM and hirsutism was due to hyperandrogenaemia. Menstrual disorders in the T1DM girls were associated also with hyperandrogenaemia unlike obese girls. Hirsutism and menstrual disorders are common in obese adolescent girls and adolescent girls with T1DM. Although hyperandrogenaemia is present in both groups of girls, the androgenic profiles of the two groups differ. The hyperandrogenaemia in the obese girls is primarily due to their decreased serum SHBG levels, whereas the hyperandrogenaemia in the girls with T1DM is due to their increased androgen production.