The Association of Hirsutism with Metabolic Syndrome

Abstract

Hirsutism, which characterized by excessive growth of terminal hair in a male pattern, is a common clinical condition in women. It may result from various causes including PCOS, non-classic adrenal hyperplasia, adrenal or ovarian tumors, or it may be idiopathic. IH is considered to be one of the most common forms of hirsutism. Because the definition of IH has varied during the last three decades, it is difficult to establish the estimate of its prevalence. Currently, IH is defined as hirsutism associated with normal ovulatory function and normal circulating serum androgen concentrations. In other words, the current diagnosis of IH depends on the exclusion of ovulatory dysfunction, hyperandrogenemia, and other androgen excess disorders. Metabolic syndrome is a group of abnormalities probably caused by IR with systemic hyperinsulinism. It consists of glucose intolerance or type 2 diabetes, arterial hypertension, atherosclerosis, obesity and dyslipidemia. The most important risk factors for the development of MetS are weight, genetics, endocrine disorders and aging. Most patients are older, obese, sedentary and have a degree of IR, stress can also be a contributing factor. As MetS is highly associated with CVD and type 2 diabetes, corroborating the association between MetS and hirsutism may provide another clue to the clinical signs and symptoms related to both diseases, but unfortunately there is little data on population based studies on this association. The current study aimed at assessing the frequency of MetS among women with hirsutism (whether IH or PCOS) compared to age matched control group. The present study is a case control study that included 60 female subjects, 30 patients with hirsutism referred as Group I [which was further subgrouped into Ia (IH), Ib (PCOS), Ic (hirsutism with MetS) and Id (hirsutism without Mets)] and 30 healthy volunteers who served as controls (Group II) that were age, and socioeconomic status matched with the patients. Pregnant and lactating females, patients having any major systemic illness (Congenital adrenal hyperplasia, acromegaly, hyperprolactinemia, thyroid dysfunction and functional hypothalamic amenorrhea based on clinical findings and laboratory investigations), patients receiving OCs or steroid therapy or any dermatological disease affecting the immune system as autoimmune disease or malignancy were excluded from this study. A photograph was taken for all patients to document the condition using a digital camera. Waist circumference was measured for all subjects & also arterial BP was measured twice with 5 minutes apart. 5ml of venous blood were withdrawn from every subject after a 12 hour fasting period to assess total testosterone, DHEA-S, LH/FSH, FBG, TG, TC, LDL-C and HDL-C. The diagnosis of MetS was based on the criteria defined by the NCEP ATP III criteria. All 60 patients were submitted to pelvic ultrasonography to detect the presence of PCOS. The diagnosis of PCOS was based on Rotterdam criteria. The current study noted a statistically significant difference between Group I and Group II as regards WC and BMI being higher in Group I, while there was no statistically significant difference noted as regards the SBP and DBP. Also there was a highly significant difference in the mean of total testosterone, DHEA-S and LH/FSH in Group I versus Group II being higher in Group I. Comparing the MetS parameters Group I and Group II revealed a significant difference in the mean TG, TC, and LDL-C being higher in Group I, while there was no significant difference as regard HDL-C and FBG. There was a significant difference between Group Ia, Group Ib and Group II as regards WC, total testosterone, DHEA-S, LH/FSH ratio, TG, TC and LDL-C being increased in Group Ib than Group Ia and Group II while there was no statistically significant difference noted as regards the SBP, DBP, FBG and HDL-C among the 3 groups The comparison between Group Ic, Group Id and Group II revealed significant difference regarding WC, BMI, total testosterone, DHEA-S, LH/FSH ratio, FBG. TG, TC and LDL-C being increased in Group Ic than Group Id and Group II while there was no statistically significant difference noted as regards the SBP, DBP, and HDL-C among the 3 groups There was a positive correlation between the presence of MetS and SBP, DBP, WC and TG. While a negative correlation between the presence of MetS and HDL-C was detected.