Hirsutismo y estados hiperandrogénicos / Hirsutism and hyperandrogenic states

Este es un artículo de revisión sobre lo que es el hirsutismo. Se expone que la mayor causa está asociada con el ovario poliquístico. Se describe la producción ovárica y suprarrenal de andrógenos en la mujer, las diferentes manifestaciones de hiperandrogenismo, las diversas clasificaciones que hay para el diagnóstico y clasificación clínica del hirsutismo y el papel que juega la 5-alfa-reductasa. Se postulan las principales etiologías, el diagnóstico y el manejo de esta patología.

This es a review article about what is hirsutism. It is exposed that the greatest cause associated is polycystic ovary. Ovarian and adrenal androgen production are described, the different manifestations of hyperandrogenism, the different classification systems for diagnosis and clinical classification of hirsutism and the role of 5-alfa-reductase. The main etiologies are postulated, as well as diagnosis and management of this pathology.

Síndrome dos ovários policísticos: tratamento das manifestações androgênicas / Polycystic ovary syndrome: treatment of androgenic manifestations

A síndrome dos ovários policísticos (SOP) é um distúrbio endócrino-metabólico muito frequente no período reprodutivo. Quando associado ao distúrbio metabólico, as mulheres com SOP podem ter ainda risco acrescido para doença cardiovascular. O objetivo deste manuscrito é descrever as repercussões metabólicas, incluindo quais as principais, como investigar e as consequências desse distúrbio sobre a saúde da mulher. É uma revisão narrativa mostrando a implicação da resistência insulínica, das dislipidemias e da síndrome metabólica sobre o sistema reprodutor e sobre o risco cardiovascular da mulher com SOP, bem como do uso de sensibilizadores de insulina no seu tratamento. Conclui-se que a correção dos distúrbios metabólicos na SOP é benéfica tanto para o sistema reprodutor quanto para o cardiovascular. A primeira linha de tratamento é a mudança de estilo de vida e a perda de peso. Na resposta inadequada, o tratamento medicamentoso está recomendado. Nas mulheres com obesidade mórbida que não tiveram bons resultados com o tratamento clínico, a cirurgia bariátrica é uma opção.(AU)

Síndrome de ovarios poliquísticos. Entidad que demanda diagnóstico temprano / Polycystic ovary syndrome, an entity demanding an early diagnosis

RESUMEN El síndrome de ovario poliquístico se ha convertido en un problema de salud pública, siendo el más común de los desórdenes endocrinos en mujeres en edad reproductiva con estudios que reportan una prevalencia de hasta un 21%. El diagnóstico de esta entidad es importante debido a que representa riesgos metabólicos, cardiovasculares y afecta la capacidad reproductiva de estas pacientes. Se realizó una revisión bibliográfica de los principales artículos relacionados sobre el tema, resumiendo los aspectos fundamentales de este problema de salud.

ABSTRACT Polycystic ovary syndrome has become a public health problem, being the most common of the endocrine disorders in reproductive-age women, with studies reporting prevalence by 21 %. The diagnosis of this entity is important because it represents metabolic and cardiovascular risk, and affects the reproductive capacity of these patients. The authors carried out bibliographic review of the main articles related with the theme, summarizing the basic aspects of this health problem.

Foeniculum vulgare as Valuable Plant in Management of Women's Health

This review paper evaluates use of Foeniculum vulgare extracts as a popular female plant in management of different ailments of women. Information in this paper was gathered from accessible sources (PubMed, Science Direct, Springer, Wiley, and Google), and traditional books (Persian or English modern traditional books), unpublished data (R&D reports, thesis and dissertation) by keywords based on the words F. vulgare or fennel and women. Efficacy of oral fennel oil in management of dysmenorrhea, premenstrual syndrome, amenorrhea, menopause, lactation, and polycystic ovary syndrome were confirmed according to results of clinical studies. Results of clinical efficacy of fennel oil on menstrual bleeding is complicated, but results of one meta-analysis study revealed that fennel oil significantly increased means of bleeding in the first menstrual periodic cycle (P = 0.001), while fennel oil had no significant effect on bleeding in the second menstrual cycle (P = 0.67). Topical and vaginal fennel extract (5%) exhibited good efficacy in treatment of sexual function, vaginal atrophy, and hirsutism. Fennel had no effect on bone density, or body mass index of menopause women. Results of clinical studies introduce fennel as a valuable medicinal plant in management of women's ailments, but understanding the mechanism of action could be the subject of future studies.

Diagnosis of an indistinct Leydig cell tumor by positron emission tomography-computed tomography

A 51-year-old perimenopausal female patient presented with hirsutism and voice thickening which was started approximately one and a half years ago. Her initial hormone assay revealed elevated plasma testosterone, 5a-dihydrotestosterone, and dehydroepiandrosterone (DHEA) levels and therefore androgen-secreting tumor was first suspected. However, the lesion was inconspicuous on transvaginal sonography, abdominal-pelvic computed tomography (CT) scan, and pelvic magnetic resonance (MRI) imaging. Consequently, 18F-fluorodeoxyglucose (FDG) positron emission tomography-CT was performed, which localized the lesion as a focal FDG uptake within the right adnexa. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed, and although visible gross mass lesions were not observed intraoperatively, pure Leydig cell tumor was pathologically confirmed within the right ovary. Plasma testosterone, 5a-dihydrotestosterone, and DHEA levels were normalized postoperatively. Clinical signs of virilization were also significantly resolved after 3-months of follow-up.

The Modified Ferriman-Gallwey Score and Hirsutism among Filipino Women

BACKGROUND: The modified Ferriman-Gallwey (mFG) score is the gold standard for the clinical evaluation of hirsutism. However, racial variations in terminal hair growth limit this tool. This study aimed to determine the mFG cut-off score among Filipino women and its association with biochemical hyperandrogenism.METHODS: A total of 128 Filipino women were included in this prospective cross-sectional study and were divided into two groups: a polycystic ovary syndrome (PCOS) group (n=28) and a non-PCOS group (n=100). The participants underwent mFG score determination, ovarian ultrasound conducted by a single sonographer, and hormone testing. The mFG cut-off score was determined based on the 95th percentile of the non-PCOS group. Logistic regression was used to analyze the relationship between mFG score and biochemical hyperandrogenism.RESULTS: Although the mFG score was generally low in both the PCOS and non-PCOS groups, the former exhibited a higher mean score than the latter (4.3±3.0 vs. 2.0±2.2, P<0.001). Normal values for the total mFG score ranged from 0 to 7. Using a cut-off score of 7, a higher proportion of hirsute women (mFG score ≥7) was observed in the PCOS group versus the non-PCOS group (17.9% vs. 5.0%, P=0.025). Elevated calculated free testosterone (FT) was also found to be significantly associated with hirsutism (odds ratio, 6.2; 95% confidence interval, 1.2 to 32.4 pmol/L; P=0.030).CONCLUSION: A score of 7 and above constitutes hirsutism in this population of Filipino women. Hirsute women are more likely than non-hirsute women to have elevated calculated FT.

Tumor ovárico de células de Leydig en una niña de 7 años que se presentó como pubarquia precoz con elevación de 17 hidroxiprogesterona / Ovarian tumor of Leydig cells in a 7-year-old girl who presented as precocious pubarche with elevation of 17 hydroxyprogesterone

Clinical case: a girl of 7 ½ years who consulted for early pubarche without thelark, with a percentile size of 75 for a genetic target size in the 10th percentile, overweight with a 90th percentile BMI, and normal blood pressure. The biochemical study showed high levels of androgens: testosterone: 7.2 ng/dL, androstenedione of 5.1 ng / ml, 17OHP: 15 ng / dL with low normal DHEAS (0.26 ug/ml), Plasma Renin Activity normal low: 0.22 ng/mL/h. Initial imaging study showed a bone age of 10 years 6 months and normal abdominal and pelvic ultrasound. Molecular study showed no pathogenic variants in the CYP21A2 gene (21 Hydroxylase). With a probable diagnosis of non-classical congenital adrenal hyperplasia (HSRNC) and no known mutation, he started treatment with hydrocortisone (12 mg/m2). At 8.7 years, pubertal development begins and braking begins with LHRH analogues, which are administered for 18 months. Despite the treatment, signs of virilization and elevation of androgens (testosterone up to 130 ng/ml) are progressively accentuated, which do not diminish when trying different corticosteroid schemes. MRI of the abdomen and pelvis shows the normal adrenal glands and a solid nodular image of 2.1 x 1.6 cm in the right ovary (Figure 2), later demonstrated with pelvic ultrasound (Figure 2). Right laparoscopic oophorectomy was performed, whose biopsy demonstrated a Leydig cell tumor. One month after surgery, all androgenic levels were normalized, so the gradual suspension of corticosteroids began. Conclusion: Although HSRNC is the most frequent pathological cause of early pubarche, when it is associated with progressive clinical and biochemical hyperandrogenism despite adequate treatment and without pathogenic variants in the CYP21A2 gene, even with high levels of 17OHP, other causes should be considered, specifically, androgen producing tumors.

Caso clínico: niña de 7½ años que consulta por pubarquia precoz sin telarquia, con talla en percentil 75 para una talla objetivo genético en percentil 10, sobrepeso con IMC percentil 90 y presión arterial normal. El estudio bioquímico mostró niveles elevados de andrógenos: testosterona: 7,2 ng/dL, androstenediona de 5,1 ng/ml, 17OHP: 15 ng/dL con DHEAS normal baja (0,26 ug/ml), Actividad de Renina Plasmática normal baja: 0.22 ng/ mL/h. Estudio de imágenes inicial mostró una edad ósea de 10 años 6 meses y ecografía abdominal y pelviana normales. Estudio molecular no mostró variantes patogénicas en el gen CYP21A2 (21 Hidroxilasa). Con diagnosticó probable de hiperplasia suprarrenal congénita no clásica (HSRNC) y sin mutación conocida,inició el tratamiento con hidrocortisona (12 mg/m2). A los 8.7 años comienza desarrollo puberal y se inicia frenación con análogos de LHRH, los cuales se administran por 18 meses. A pesar del tratamiento se acentúan progresivamente los signos de virilización y hayelevación de los andrógenos (testosterona hasta 130 ng/ml), que no disminuyen intentando diferentes esquemas de corticoides. Se realiza RM de abdomen y pelvis que muestra las glándulas suprarrenales normales y una imagen nodular sólida de 2.1 x 1.6 cm en el ovario derecho (Figura 2), demostrada posteriormente con Ecografía pelviana (Figura 2). Se realiza ooforectomía derecha por vía laparoscópica, cuya biopsia demostró un tumor de células de Leydig. Un mes después de la cirugía, se normalizan todos los niveles androgénicos por lo que se inició la suspensión gradual de los corticoides. Conclusión: Aunque la HSRNC es la causa patológica más frecuente de la pubarquia precoz, cuando se asocia con un hiperandrogenismo clínico y bioquímico progresivo a pesar de un tratamiento adecuado y sin variantes patógenicas en el gen CYP21A2, incluso con niveles elevados de 17OHP, otras causas deben ser consideradas, específicamente tumores productores de andrógenos.

Síndrome de Ovario Poliquístico (SOP) en la adolescencia / Polycystic Ovary Syndrome (PCOS) during adolescence

El síndrome de poliquistosis ovárica (SOP) es un cuadro que acompaña a la mujer durante toda su vida y se caracteriza por hiperandrogenismo y anovulación crónica. Se presenta comúnmente en la adolescencia y es eldesorden endócrino más frecuente en mujeres en edad reproductiva en el mundo. A largo plazo se asocia con morbilidad significativa que incluye alteraciones en la salud reproductiva, disfunción psicosocial, síndrome metabólico, enfermedad cardiovascular e incremento en el riesgo de cáncer. Su etiología es desconocida aún, sin embargo, a lo largo de las tres últimas décadas, diferentes grupos de expertos en el mundo han elaborado guías para el diagnóstico y manejo de esta enfermedad. Existen tres grupos diferentes de criterios en el mundo pero están basados principalmente en información y experiencia en el manejo de mujeres adultas. Estos criterios diagnósticos no son completamente trasladables a las adolescentes. El objetivo de este artículo es acercar al pediatra clínico los elementos para alcanzar un entendimiento práctico y simplificar el manejo inicial del diagnóstico del cuadro de SOP en la adolescencia, concientizar acerca de las comorbilidades asociadas y su posibilidad de prevención para evitar riesgos en la vida adulta.

The polycystic ovarian syndrome (PCOS) is a lifelong disorder characterized by hyperandrogenism and chronicanovulation. It becomes manifest soon after puberty and it is the most frequent endocrine disorder in women at reproductive age in the world. In the long term it is associated with significant morbidity that includes alterations in reproductive health, psychosocial dysfunction, metabolic syndrome, cardiovascular disease and increased risk of cancer. Its etiology is still unknown, however, over the last three decades; several guidelines for the diagnosis and management of this disease have been developed. Three different sets of diagnostic criteria have been established to define this disease in adult women, but these diagnostic criteria are not completely transferable to adolescents. The objective of this article is to give pediatricians the elements for a practical understanding to simplify the initial management of the diagnosis of PCOS in adolescence and to raise awareness on the likelihood of associated comorbidities and that appropriate intervention could prevent later complications in adult life

Reconhecimento e diagnóstico dos sintomas cutâneos do hiperandrogenismo em mulheres: proposta do Grupo Appropriate Care for Women with Androgen Excess (AWARE)) / Recognition and diagnosis of hyperandrogenic skin symptoms in women: proposal of the Appropriate Care for Women with Androgen Excess group (AWARE))

O hiperandrogenismo representa um problema de saúde pública complexo. Essa condição pode acome- ter 1/5 das mulheres na idade reprodutiva e apresenta um impacto negativo importante na qualidade de vida. As mulheres com hiperandrogenismo podem apresentar uma combinação de diferentes sintomas e repercussões clínicas. Os sintomas cutüneos incluem a seborreia, acne, hirsutismo e aIopecia. Trata-se de uma condição desafiadora tanto para as mulheres afetadas quanto para os profissionais de saúde. A nomenclatura atribuída ao hiperandrogenismo é confusa e faltam ainda recomendações diagnósticas e terapêuticas padronizadas. O grupo Appropriate Care for Women with Androgen Excede (AWARE) foi criado com proposta de aborda os aspectos confusos e inconclusivos do hiperandrogenismo. Foram elaborados protocolos simplificados referentes ao diagnóstico e tratamento do hiperandrogenismo visando contribuir de forma mais eficaz com os médicos em seus diferentes cenários de atuação. O roteiro para o reconhecimento e abordagem dos sintomas cutâneos do hiperandrogenismo em mulheres compreende perguntas chaves e ações específicas, sinalizando para a indicação de métodos propedêuticos adicionais.(AU)

Hyperandrogenism is a complex public health problem. This condition can affect 1/5 of women in repro- ductive age and has a significant negative impact on quality of life. Women with hyperandrogenism may exhibit a combination of different symptoms and clinical repercussions. Cutaneous symptoms include seborrhea, acne, hirsutism, and alopecia. It is a challenging condition for both affected women and health professionals.The nomenclature attributed to hyperandrogenism is confusing, and standard diagnostic and therapeutic recommendations are lacking. The Appropriate Care for Women with Androgen Excess (AWARE) group was created to address the confusing and inconclusive aspects of hyperandrogenism. Simplified protocols have been developed for the diagnosis and treatment of hyperandrogenism, aiming to contribute more effectively to physicians in their different settings.The roadmap for recognizing and approaching the cutaneous symptoms of hyperandrogenism in women comprises key questions and specific actions, signaling for indication of additional propaedeutic methods.(AU)

Managing polycystic ovary syndrome in primary care

Polycystic ovary syndrome (PCOS) presents with a spectrum of conditions resulting from androgen excess, anovulation and metabolic syndrome. Patients with PCOS may see their primary care physicians for various presentations, including hirsutism, acne, menstrual irregularities, infertility, obesity, and psychiatric disorders such as anxiety and depression. Management of these patients should include screening for Type 2 diabetes mellitus, dyslipidaemia and hypertension. Treatment should be targeted to each patient's phenotype and personal expectations such as desire for pregnancy. Psychological well-being due to the effects on physical appearance is also an important consideration. Diet and exercise are major components in the management of patients with PCOS and obesity. The first-line therapy for fertility and metabolic syndrome in PCOS is lifestyle modification with diet and exercise, followed by pharmacological therapy.

Síndrome cornelia de lange, fenotipo III / Cornelia de lange syndrome, phenotype III

El Síndrome de Cornelia de Lange es un trastorno del desarrollo poco frecuente, heterogéneo genéticamente, que se define en su forma clásica por hipocrecimiento antenatal y postnatal, microcefalia, rasgos faciales distintivos, sinofridia e hirsutismo, retraso mental y micromelia. Objetivo: dar a conocer las características clínicas de los pacientes con este síndrome para realizar diagnósticos oportunos, estudios pertinentes y manejos multidisciplinarios en los pacientes afectados. Caso Clínico, lactante femenina, 19 meses de edad, con antecedentes maternos: 17 años, embarazo de 34 semanas de gestación, con un control prenatal, atendida en Hospital Santa Bárbara Integrado, ingresada para uteroinhibición sin lograr respuesta y desencadena trabajo de parto. Recién nacida, femenina, cefálica, peso de 1,625 g, perímetro cefálico 29.5 cm, malformaciones en miembros superiores, ingresada a sala de neonatos por distrés respiratorio y prematurez. Evaluada por pediatra, quien describe características dismórficas. Al examen físico: focomelia, micromelia, pestañas largas y abundantes, sinofridia e hirsutismo. En la radiografía se observó: agenesia de ambos cubitos, todos los hallazgos clínicos y laboratoriales compatibles con Síndrome de Cornelia de Lange. No se realizó ecocardiograma ni estudios genéticos, el diagnóstico de este síndrome fue clínico. A los 19 meses fue reevaluada y se encontró: peso 3,600 g, perímetro cefálico 34.5 cm y talla 55 cm, evidente retraso del crecimiento, mental y psicomotor. Conclusión: los pacientes con este síndrome deben ser diagnosticados fundamentalmente por clínica, luego realizar estudios imagenológicos para descartar otras anomalías. Además, el tratamiento debe ser integral...(AU)

Association between Lipid Accumulation Product and Hirsutism in Patients with Polycystic Ovary Syndrome / Associação entre lipid accumulation product (LAP) e hirsutismo na síndrome do ovário policístico

Objective Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder in women between menarche and menopause. Clinical hyperandrogenism is the most important diagnostic criterion of the syndrome, which manifests as hirsutism in 70% of cases. Hirsute carriers of PCOS have high cardiovascular risk. Lipid accumulation product (LAP) is an index for the evaluation of lipid accumulation in adults and the prediction of cardiovascular risk. The aim of this study was to evaluate the association between LAP and hirsutism in women with PCOS. Methods This was a cross-sectional observational study of a secondary database, which included 263 patients who had visited the Hyperandrogenism Outpatient Clinic from November 2009 to July 2014. The exclusion criteria were patients without Ferriman-Gallwey index (FGI) and/or LAP data. We used the Rotterdam criteria for the diagnosis of PCOS. All patients underwent medical assessment followed by measurement and recording of anthropometric data and the laboratory tests for measurement of the following: thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, total testosterone, sex hormone binding globulin, 17-α-hydroxyprogesterone (follicular phase), glycohemoglobin A1c, and basal insulin. In addition, the subjects underwent lipid profiling and oral glucose tolerance tests. Other laboratory measurements were determined according to clinical criteria. LAP and the homeostatic model assessment index (HOMA-IR) were calculated using the data obtained. We divided patients into two groups: the PCOS group with normal LAP (< 34.5) and the PCOS group with altered LAP (> 34.5) to compare the occurrence of hirsutism. For statistical analysis, we used SPSS Statistics for Windows(r) and Microsoft Excel programs, with descriptive (frequencies, percentages, means, and standard deviations) and comparative analyses (Student's t-test and Chi-square test). We considered relations significant when the p-value was≤0.05. Results LAP was high in most patients (n = 177; 67.3%) and the FGI indicated that 58.5% of the patients (n = 154) had hirsutism. The analysis by LAP quartiles showed a positive correlation (p = 0.04) among patients with a high FGI and an upper quartile LAP (> 79.5) when compared with those with LAP < 29.0 (lower quartile). Conclusion This study demonstrated an association between high LAP and hirsutism. The FGI could represent a simple and low-cost tool to infer an increased cardiovascular risk in women with PCOS.

Objetivo A síndrome dos ovários policísticos (SOP) é o distúrbio endócrino mais comumemmulheres entre amenarca e a menopausa. O hiperandrogenismo clínico é o critério diagnóstico mais importante da síndrome, que se manifesta como hirsutismo em70% dos casos. Portadores de SOP hirsutas têmelevado risco cardiovascular. O Lipid accumulation product (LAP) é um índice para a avaliação da acumulação de lípidos nos adultos e é um preditor de risco cardiovascular. O objetivo deste estudo é avaliar a associação entre LAP e hirsutismo em portadoras da SOP. Métodos Estudo observacional transversal de banco de dados secundário, que incluiu 263 pacientes do Ambulatório de Hiperandrogenismo no período de novembro de 2009 a julho de 2014. Foram excluídas pacientes sem o índice de Ferriman-Gallwey e/ ou LAP. Foram utilizados como critérios diagnósticos da SOP os critérios de Rotterdam. Todas as pacientes foram submetidas à avaliação médica seguida da aferição e registro dos dados antropométricos e a realização dos seguintes exames laboratoriais: hormônio estimulante da tireoide (TSH), hormônio folículo estimulante (FSH), prolactina (PRL), Testosterona total, globulina ligadora dos hormônios sexuais (SHBG), 17-α- hidroxiprogesterona, (fase folicular), perfil lipídico, teste oral de tolerância à glicose, glico-hemoglobina a1C, insulina basal. Outras dosagens laboratoriais foram determinadas à critério clínico. O LAP e o HOMA-IR (homeostatic model assessment) foram calculados com os dados obtidos. As pacientes foram divididas em dois grupos: grupo das portadoras de SOP com LAP normal (LAp < 34,5) e grupo das portadoras de SOP com LAP alterado (LAP >34,5) para as comparações do hirsutismo. Para a análise estatística, foram utilizados os programas SPSS Statistics for Windows(r) e Microsoft Excel(r), sendo feitas análises descritivas (frequências, percentuais, médias, desviospadrão) e comparativas (t-Student e qui-quadrado). Foram consideradas relações significativas quando p-valor foi menor ou igual a 0,05. Resultados O LAP foi elevado na maioria das pacientes (n = 177; 67,3%) e o índice de Ferriman-Gallwey (IF) demonstrou que 58,5% das pacientes (n = 154) eram hirsutas. A análise por quartis de LAP, demonstrou correlação positiva (p = 0,04) entre pacientes comIF elevado e LAP no quartil superior (>79,5) quando comparadas àquelas com LAP menor que 29,0 (quartil inferior). Conclusão O estudo demonstrou associação do LAP elevado e hirsutismo. O escore de Ferriman-Gallwey poderia representar uma ferramenta simples e de baixo custo para inferir risco cardiovascular aumentado em portadoras da síndrome.

Adrenal Insufficiency in 6-Year-Old Boy with Pneumococcal Meningitis

A 6-year-old boy with acute onset fever, mental change, and vomiting was admitted to the intensive care unit. He had neck stiffness and positive Kernig/Brudzinski sign. He showed neither skin pigmentation nor hirsutism. Brain magnetic resonance image showed diffuse sulcal T2 fluid attenuated inversion recovery hyperintensity in bilateral cerebral hemisphere. We started intravenous vancomycin and ceftriaxone. There was streptococcus pneumoniae in cerebrospinal fluid (CSF) culture. He showed no improvement of mental change and hemodynamic instability. His adrenocorticotropic hormone and cortisol level was 5.47 pg/mL and 15.08 µg/dL. We suspected adrenal insufficiency and prescribed intravenous hydrocortisone (50 mg/m2/day). Mental change and hemodynamic instability were improved after that. The CSF culture was negative 24 days after admission and he was discharged with oral hydrocortisone (10 mg/m2/day). In synacthen test (250 µg), basal and 60 minutes 17-OH-progesterone level was 3.84 ng/mL and 5.04 ng/ mL. We suspected non classic congenital adrenal hyperpalsia and planed further work up.

Ferriman-Gallwey score correlates with obesity and insulin levels in polycystic ovary syndrome: an observational study / Correlação da escala de Ferriman-Gallwey com a obesidade e níveis de insulina na síndrome dos ovários policísticos: um estudo observacional

BACKGROUND: The Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy and one of the main causes of infertility in women. OBJECTIVES: This study aimed to evaluate the correlation between clinical hyperandrogenism assessed by modified Ferriman-Gallwey (F-G) score and metabolic parameters in Polycystic Ovary Syndrome women. METHODS: This observational study included fifty Polycystic Ovary Syndrome subjects. Detailed information about body mass index (BMI) and abdominal circumference (AC) were obtained from each subject. F-G score was applied to assess hirsutism through visual method. Serum levels of insulin, glucose and testosterone were measured. RESULTS: A positive correlation was observed between F-G score with body mass index, abdominal circumference and insulin. CONCLUSIONS: Obesity, mainly abdominal adipose tissue, and insulin levels correlate with hyperandrogenism in Polycystic Ovary Syndrome women, analyzed by F-G score. F-G score could be a marker to evaluate metabolic disorders in Polycystic Ovary Syndrome women.

JUSTIFICATIVA: A Síndrome dos Ovários Policísticos (SOP) é a endocrinopatia mais comum e uma das principais causas de infertilidade em mulheres. OBJETIVOS: O presente estudo teve como objetivo avaliar a correlação entre hiperandrogenismo clínico, avaliado pela escala de Ferriman-Gallwey (FG) modificada e parâmetros metabólicos em mulheres com a Síndrome dos Ovários Policísticos. MÉTODOS: Este estudo observacional incluiu cinquenta mulheres com Síndrome dos Ovários Policísticos. Informações detalhadas sobre o índice de massa corporal (IMC) e circunferência abdominal (CA) foram obtidas de cada participante. A escala FG foi aplicada para avaliar o hirsutismo através do método visual. Níveis séricos de insulina, glicose e testosterona foram também avaliados. RESULTADOS: Observou-se uma correlação positiva entre a escala FG e o índice de massa corporal, circunferência abdominal e insulina. CONCLUSÕES: A obesidade, principalmente o tecido adiposo abdominal, e os níveis de insulina se correlacionam com hiperandrogenismo em mulheres com Síndrome dos Ovários Policísticos, analisados por meio da escala FG. Desta forma, esta escala poderia ser um marcador para avaliar distúrbios metabólicos em mulheres com Síndrome dos Ovários Policísticos.

Hirsutismo pós-menopausa: caso clínico raro de hipertecose ovárica / Post-menopausal hirsutism: a rare case of ovarian hyperthecosis

Durante o climatério podem ocorrer sinais clínicos de hiperandroginismo. Contudo quadros de virilização exigem investigação para exclusão de uma fonte produtora de androgênios. Doente de 66 anos, com menopausa espontânea aos 50, referenciada à consulta de ginecologia por hirsutismo após a menopausa, com agravamento no último ano e episódios demetrorragia que não valorizava. Ao exame objetivo tinha masculinização da voz, alopécia androgênica, aumento da pilosidade na face, tronco e membros e hipertrofia do clitóris.Feita ecografia endovaginal que revelou espessamento endometrial e ovários aumentados de volume para a idade; estudo analítico que demonstrou um valor de testosterona total elevado (225ng/dL); tomografia computadorizada da suprarrenal e ressonância magnética crânio-encefálica que não revelaram alterações; e histeroscopia com remoção de pólipo endometrial, associado a hiperplasia endometrial simples sem atipia. Submetida a histerectomia total com anexectomia bilateral. O estudo histológico concluiu tratar-se de hipertecose ovárica. Seis meses após a cirurgia apresentava normalização da testosterona sérica, acentuada redução do hirsutismo e melhoria da alopécia.O diagnóstico de hiperandrogenismo em mulheres na pós-menopausa constitui um desafio. Os meios complementares de diagnóstico nem sempre permitem detectar a origem da hiperandrogenemia. O tratamento da hipertecose ovárica melhora o hirsutismo e pode reduzir o risco de patologia maligna hormonodependente.

tMild clinical signs of hyperandrogenism such as hirsutism may arise during the menopausal transition as part of the aging process. However, development of virilization may be interpreted as the presence a specific source of androgen excess. 66 year-old menopausal woman, with a record of progressive hirsutism since menopausal age (50 years-old) exacerbated over the past year. Episodes of metrorrhagia were not valued by the patient. Physical examination showed deepening of voice, frontotemporal alopecia, hirsutism in face, trunk and limbs and hypertrophy of the clitoris. A transvaginal ultrasound revealed a thickened endometrium and enlarged ovaries considering her age and analytical study showed an increase of total testosterone (225ng/dL). No changes were detected at computerized tomography of adrenals and cerebral magnetic resonance. Performed an hysteroscopy with removal of endometrial polyp, associated to simple endometrial hyperplasia without atypia. The histological diagnosis after hysterectomy and bilateral salpingo-oophorectomy, revealed a ovarian hyperthecosis. Six months after surgery it was observed a testosterone within the normal range, marked hirsutism reduction and alopecia improvement.Diagnosis of hyperandrogenism in postmenopausal is a challenging task. Imaging techniques do not always reveal the source of excess androgens. The ovarian hyperthecosis treatment effectively improves hirsutism and reduces the risk of hormone-dependent tumors.

Actualización del síndrome de ovario poliquístico y su importancia en dermatología / Update of polycystic ovary syndrome and its importance in dermatology

El Síndrome de Ovario Poliquístico es un trastorno endocrino común que afecta a mujeres en edad reproductiva que puede causar problemas metabólicos y deterioro psicosocial importante. Las manifestaciones dermatológicas más frecuentes del hiperandrogenismo incluyen acné, hirsutismo y alopecia, cuyo reconocimiento es esencial para hacer un diagnóstico precoz. Las modalidades de tratamiento incluyen terapia hormonal con el objetivo de modular la producción de andrógenos y su acción, así como tratamientos no hormonales dirigidos a condiciones dermatológicas específicas.

Polycystic ovarian syndrome is a common endocrine disorder that affects women of reproductive age, which can cause metabolic, reproductive and psychosocial impairment. The most common skin manifestations of hyperandrogenism are acne, hirsutism and alopecia, whose recognition is essential for early diagnosis. There are several treatment modalities, including hormonal therapy in order to modulate androgen production and their effects, as well as other non hormonal treatments targeted to specific dermatologic conditions.

Clinical Guidelines for the Diagnosis and Treatment of Cushing's Disease in Korea

Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities.