Investigation of body mass index, insulin resistance and diabetes in patients with hirsutism.

INTRODUCTION: Obese woman with hirsutism have increased risk for developing insulin resistance and diabetes mellitus. AIM: To evaluate patients with hirsutism, report the hormone levels, body mass index (BMI), insulin resistance and diabetes in our study population and compare our results with those of similar research conducted in other countries. MATERIAL AND METHODS: Hormones were measured with radioimmunoassay/immunoradiometric assay methods. Oral glucose tolerance test was done only in a selected group of women (with positive anamnesis for diabetes, women with polycystic ovary syndrome (PCOS) and overweight/obese women). The level of blood glucose was measured after drinking the liquid containing 75 g glucose. Blood was taken to measure glucose, insulin and C-peptide levels after 30 min, 60 min and 3 h. RESULTS: Women with PCOS (27.4%) had higher BMI than women with other causes of hirsutism. Among 135 of the women with hirsutism, 9.6% were underweight, 60% were with normal weight, 20.7% were overweight and 9.6% were obese. Obesity was more frequent in PCOS and hyperandrogenism groups. Women with hirsutism had higher levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), total testosterone, free testosterone, lower levels of sex hormone-binding globulin (SHBG). Insulin resistance was present in 20 (14.8%) women and diabetes in 2 (1.4%) women. CONCLUSIONS: Obesity was associated with increased hirsutism. In our study we found that insulin resistance should be assessed in hirsute women with PCOS regardless of their BMI as insulin resistance was found in hirsute women irrespective of whether they were overweight, obese, of normal weight or underweight. Groups at risk (hirsute, obese, diabetes) should be identified and treated.

Grading of hirsutism based on the Ferriman-Gallwey scoring system in Kosovar women.

INTRODUCTION: Hirsutism is defined as excess terminal hair that commonly appears in a male pattern in women. AIM: To examine severity and distribution of hirsutism with Ferriman-Gallwey visual scoring system in hirsute women in Kosovo. MATERIAL AND METHODS: This prospective study included 160 women, 135 with hirsutism and 25 as a control group. The Ferriman-Gallwey score is used to evaluate hirsutism. The examiner scored the subjects on a scale of 0-4 for terminal hair growth on eleven different body areas according to the Ferriman-Gallwey scoring system. An Ferriman-Gallwey score of 8 or more was considered diagnostic of hirsutism. A thorough physical examination with specific emphasis on signs of virilization (including frontal baldness, loss of female body contours, increased muscularity, acne, clitoromegaly, and atrophy of breast) was done in all patients. RESULTS: The positive family history of hirsutism was present in 63.7%. In 51.1% of women with hirsutism, the menstrual cycle was regular, 25.2% had oligomenorrhea, 13.3% amenorrhea, 7.4% dysmenorrhea, 1.5% polymenorrhea and 1.5% oligomenorrhea and dysmenorrhea. The age group with the highest scoring comprised women under 20 years and 20-29 years group with an average value of 23.9 and 24.8, respectively. In our study population, 40% of the patients had an Ferriman-Gallwey score of 3 for the upper lip and 47% of patients had an Ferriman-Gallwey score of 3 for the chin. CONCLUSIONS: The Ferriman-Gallwey scoring system has a great significance and value to establish the diagnosis of hirsutism and is an acceptable screening method.

Acne in hirsute women.

INTRODUCTION: Acne and hirsutism are common manifestations of hyperandrogenism. AIM: To investigate whether or not acne is present in women with hirsutism, associated with different clinical, endocrine and ultrasonographic features. MATERIAL AND METHODS: The prospective study included 135 women with hirsutism, aged 14-46 years. We measured the levels of hormones with radioimmunoassay/immunoradiometric assay methods. RESULTS: Acne were present in 63 (47.6%) women with hirsutism. Sixty women had mild forms of acne, including: whiteheads, blackheads, papules and pustules. Only 3 women had moderate to severe acne, including nodules. In a group of women with hirsutism and acne, 6 (9.5%) were obese. In our study we found a high prevalence of androgen excess among hirsute women with acne: total testosterone was increased in 79%, free testosterone in 20.6%, androstenedione in 69.8%, dehydroepiandrosterone sulfate (DHEAS) in 30.1%, 17-OH-progesterone 68.2% and sex hormone-binding globulin (SHBG) was decreased in 33.3% of women. Women with hirsutism and acne have received oral contraceptives for a year, without or in a combination with other medication. Thirty-four (53.9%) women have shown improvement in hirsutism and acne. CONCLUSIONS: In this study we found a high prevalence of acne in hirsute women. The prevalence of acne was higher in polycystic ovarian syndrome. Since these women have associated endocrine changes it is important to correct them with hormonal therapy.