Reproductive Hormones and Anthropometry: A Follow-Up of PCOS and Controls From Perimenopause to Older Than 80 Years

CONTEXT

There is a lack of knowledge about hormonal and anthropometric changes in women with polycystic ovary syndrome (PCOS) after the menopause.

OBJECTIVE

This work aimed to study reproductive hormones and anthropometry in women with PCOS older than 80 years.

DESIGN AND SETTING

This prospective cohort study was conducted at a university hospital.

PATIENTS

A well-defined cohort of women with PCOS, previously examined in 1987 and 2008 (21 years) was reexamined in 2019 (11 years). Of the original cohort (n = 37), 22 women were still alive and 21 (age range, 72-91 years) participated. Comparisons were made with age-matched controls (n = 55) from the original control cohort (body mass index [BMI] similar to PCOS women). The results were compared with results from 1987 and 2008.

INTERVENTIONS

Hormonal measurements and a physical examination were performed.

MAIN OUTCOME MEASURES

Follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), hirsutism score, BMI, and waist to hip ratio (WHR) were measured.

RESULTS

At mean age 81 years, FSH levels were lower in women with PCOS (50 vs 70 IU/L) who were still more hirsute than controls (33% vs 4%). No differences were found in FAI, testosterone, SHBG or LH levels, BMI, or WHR. From perimenopausal age until the present age, levels of testosterone and FAI continued to decline in women with PCOS. SHBG levels continued to increase with age. FSH had not changed over time during the last 11 years.

CONCLUSIONS

Women with PCOS at age 72 to 91 had lower FSH levels, remained clinically hyperandrogenic, and had similar FAI and body composition as controls.

Prenatal Androgenization of Ewes as a Model of Hirsutism in Polycystic Ovary Syndrome

The main clinical feature associated with hyperandrogenism in polycystic ovary syndrome (PCOS) in humans is hirsutism, where hair increases its length, pigmentation, and particularly its diameter. Currently, it is not known whether PCOS animal models also exhibit changes in the hair. Therefore, the aim of this study was to explore the wool characteristics in sheep prenatally androgenized (PA) with testosterone propionate. After 4 and 13 months of life, wool was collected from the top of the shoulder of both females and males (both androgenized and controls). The offspring sheep were followed for up to 19 months of life to evaluate testosterone and androstenedione serum levels by ultra-high-performance liquid chromatography-tandem mass spectrometry, determine insulin and glucose response to intravenous glucose tolerance test, and address estrus cyclicity during the second breeding season. PA male animals showed a reduction in wool fiber diameter at 4 months of age compared with controls (P = 0.02) but not at 13 months, whereas PA females showed increased hair diameter at 13 months (P = 0.002), with no difference at 4 months. No substantial changes in other hair parameters (length, color, and medullation) were identified. In addition, increased levels of serum testosterone were observed in PA female sheep compared with controls at 12 months (P = 0.03). Our results indicate for the first time, to our knowledge, that changes in wool fiber diameter observed in PA ewes replicate, at the translational level, the increase in hair diameter in hirsute women with PCOS.

The effect of CAG repeats length on differences in hirsutism among healthy Israeli women of different ethnicities

PURPOSE

Variations in the degree of hirsutism among women of different ethnic backgrounds may stem from multiple etiologies. Shorter length of the polymorphic CAG repeats of the androgen receptor (AR) gene may be associated with increased activity of the receptor leading to hirsutism. We hypothesized that there are ethnic differences in the degree of hirsutism that is unrelated to androgen levels among Israeli women, and that the CAG repeats length may contribute to these differences. Anti-androgenic therapies, such as spironolactone, could be suggested if a shorter CAG repeats length is found to affect the difference in the degree of hirsutism between the ethnic groups.

METHODS

Healthy Israeli Jewish women aged 18-45 years of Ashkenazi and non-Ashkenazi origin were invited to participate. Hirsutism was assessed using the simplified Ferriman-Gallwey (sFG) score, and serum total testosterone levels were measured as well. The CAG repeats length was determined by PCR. Methylation-sensitive methods were used to detect the fractional activity of each allele, and the weighted mean was calculated for the CAG repeats length.

RESULTS

One-hundred and eight women were recruited (49 Ashkenazi and 59 non-Ashkenazi). The Ashkenazi women had a significantly lower degree of hirsutism (P<0.01), lower mean BMI (P = 0.003), total testosterone levels (P = 0.017), and longer weighted bi-allelic CAG repeats mean (P = 0.015) compared to non-Ashkenazi women. For the group as a whole, there was a significant negative correlation between the number of CAG repeats in the AR gene and the sFG score, while the number of repeats was not related to testosterone levels. Stepwise logistic regression revealed that ethnic origin and the CAG repeats length were the strongest factors affecting hirsutism (P<0.001, P = 0.03, respectively).

CONCLUSIONS

There is a significant difference in the degree of hirsutism between Ashkenazi and non-Ashkenazi women in Israel that is partially explained by CAG repeats length.

[Dermatologic laser surgery]

In this article we give an overview of which skin conditions that are currently treated with laser and explains the basic principles of treatment. In addition, we summarize recommendations of the Danish Dermatological Society for demarcation of medical treatments which can be provided free of charge from cosmetic self-payment treatments.

A novel insulin receptor mutation in an adolescent with acanthosis nigricans and hyperandrogenism

Insulin receptor mutations cause extreme insulin resistance resulting in acanthosis nigricans and hyperandrogenism. We report a pre-menarchal adolescent female with normal weight, with severe acanthosis nigricans, acne, and hirsutism. Initial investigation revealed elevated fasting and post-prandial insulin and high testosterone and androstenedione levels. Her father had frequent complaints of hypoglycemia. Coding sequence and splice junction analysis of the INSR gene, in our patient and her father, revealed a heterozygous missense mutation in the β subunit of the insulin receptor (Arg1131Trp), resulting in receptor loss of function. Metformin therapy and carbohydrate control improved acanthosis and menarche ensued within 3 months. Our case highlights the importance of distinguishing insulin resistance commonly associated with obesity from monogenic defects. Although, there is no consensus on treatment of children with monogenic forms of insulin resistance due to its rarity, dietary and lifestyle modifications and insulin-sensitizing agents play a key role in management.

Recurrent Mutations in the Basic Domain of TWIST2 Cause Ablepharon Macrostomia and Barber-Say Syndromes

Ablepharon macrostomia syndrome (AMS) and Barber-Say syndrome (BSS) are rare congenital ectodermal dysplasias characterized by similar clinical features. To establish the genetic basis of AMS and BSS, we performed extensive clinical phenotyping, whole exome and candidate gene sequencing, and functional validations. We identified a recurrent de novo mutation in TWIST2 in seven independent AMS-affected families, as well as another recurrent de novo mutation affecting the same amino acid in ten independent BSS-affected families. Moreover, a genotype-phenotype correlation was observed, because the two syndromes differed based solely upon the nature of the substituting amino acid: a lysine at TWIST2 residue 75 resulted in AMS, whereas a glutamine or alanine yielded BSS. TWIST2 encodes a basic helix-loop-helix transcription factor that regulates the development of mesenchymal tissues. All identified mutations fell in the basic domain of TWIST2 and altered the DNA-binding pattern of Flag-TWIST2 in HeLa cells. Comparison of wild-type and mutant TWIST2 expressed in zebrafish identified abnormal developmental phenotypes and widespread transcriptome changes. Our results suggest that autosomal-dominant TWIST2 mutations cause AMS or BSS by inducing protean effects on the transcription factor's DNA binding.

[RISK FACTORS AND CLINICAL PECULIARITIES OF SECONDARY OLIGOMENORRHEA IN ADOLESCENT GIRLS]

Risk factors related to secondary oligomenorrhea (SOM) are the presence of chronic extragenital pathology, abrupt changes in body mass during a short period of time, a burdened perinatal history at the onset of SOM after a year of regular menstruations. Adolescent girls with SOM differ from their healthy peers by a frequent occurrence of hirsutism, obesity and body mass deficit, uterine hypoplasia.

"Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging

Hyperandrogenism is a common finding in premenopausal age and is generally caused by polycystic ovarian syndrome or other benign disease. Androgen-secreting tumors represent only 0.2 % of the causes of hyperandrogenism and usually present with severe clinical features, abrupt onset, and very high androgens levels. We describe here three cases of occult ovarian Leydig cell tumors suspected on the basis of severe clinical features of hyperandrogenism rapidly worsening, with elevated serum total testosterone levels, in which bilateral ovariectomy was performed and tumor was confirmed by post-operative histology. In all three cases, imaging was negative for ovarian tumor. Moreover, in one case the confounding concomitant finding of bilateral adrenal masses posed an additional challenge. Our experience highlights that testosterone levels represent the most helpful marker in the diagnosis of androgen-secreting ovarian tumor. In the absence of imaging findings, bilateral ovariectomy should be indicated, if supported by unequivocal clinical and laboratory data.

Clinical, hormonal and metabolic characteristics of polycystic ovary syndrome among obese and nonobese women in the Croatian population

Obesity has a deteriorating impact on women with PCOS, although prevalence and the impact of specific traits of PCOS remain inconstant in different populations. Therefore, the aim of this study was to explore the differences in clinical, hormonal and metabolic features between obese and nonobese Croatian women diagnosed as having PCOS according to Rotterdam consensus criteria. The study included 74 obese and 208 nonobese women with PCOS. Clinical, biochemical and metabolic variables were compared among those PCOS subgroups. Obese subjects with PCOS had a higher risk of developing oligo-amenorrhea (OR 3.7; 95% CI, 1.1-12.5) and lower risk for developing hirsutism and acne (OR 0.2; 95% CI, 0.1-0.3 and OR 0.8; 95% CI 0.5-1.4, respectively). Obese PCOS subjects also had a higher risk of developing hyperandrogenemia (OR 2.5; CI 95% 0.9-6.7), insulin resistance (OR 4.5; CI 95%, 2.6-7.9), hypercholesterolemia (OR 5.0, CI 95% 2.5-10.2), hypertriglyceridemia (OR 5.2; 95% CI, 2.9-9.2) as well as elevated serum CRP levels (OR 4.1; 95% CI 1.4-12.2) compared to nonobese PCOS women. In conclusion, nonobese Croatian women with PCOS are more inclined to cosmetic problems associated with PCOS then metabolic ones. This is the first study to report the impact of obesity on acne and irregular menses as a study outcome. Obesity deteriorates menstrual regularity, insulin sensitivity and lipid profile in Croatian women with PCOS; therefore one of the fundamental treatment strategies of PCOS should be obesity prevention.

Routine screening for Cushing's syndrome is not required in patients presenting with hirsutism

CONTEXT

Prevalence of Cushing's syndrome (CS) in patients presenting with hirsutism is not well known.

OBJECTIVE

Screening of CS in patients with hirsutism.

SETTING

Referral hospital.

PATIENTS AND OTHER PARTICIPANTS

This study was carried out on 105 patients who were admitted to the Endocrinology Department with the complaint of hirsutism.

INTERVENTION

All the patients were evaluated with low-dose dexamethasone suppression test (LDDST) for CS.

MAIN OUTCOME MEASURE

Response to LDDST in patients presenting with hirsutism.

RESULTS

All the patients had suppressed cortisol levels following low-dose dexamethasone administration excluding CS. The etiology of hirsutism was polycystic ovary syndrome in 79%, idiopathic hirsutism in 13%, idiopathic hyperandrogenemia in 6%, and nonclassical congenital hyperplasia in 2% of the patients.

CONCLUSION

Routine screening for CS in patients with a referral diagnosis of hirsutism is not required. For the time being, diagnostic tests for CS in hirsute patients should be limited to patients who have accompanying clinical stigmata of hypercortisolism.

Clinical and biochemical characteristics of polycystic ovary syndrome in Croatian population

Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting women of reproductive age. There are many typical signs and symptoms that allow for the diagnosis of PCOS depending on the criteria used. Interestingly, ethnicity influences the extent of these signs and symptoms; therefore, the frequency of symptoms varies between different countries and ethnic groups. The prevalence of this syndrome in Croatia is unknown, and it's clinical and biochemical characteristics have not yet been reported. During this study, we used the Rotterdam criteria to evaluate 365 Croatian women with PCOS, and compared them to 304 age matched controls to assess the clinical and biochemical abnormalities that occur in PCOS patients. The mean age of PCOS patients at presentation was 26.1 +/- 5.9 years and of controls were 28.0 +/- 4.2 years. Women with PCOS has significantly higher body mass index (BMI) than the control group, although in both groups most patients had normal weight (76.2% vs. 87.8%). Abdominal distribution of fat tissue was similar in both groups. Menstrual cycle abnormalities were observed in 90.7% of PCOS patients, and ultrasonographic appearance of polycystic ovaries was reported in 97.3% of PCOS cases. Nearly 75% of patients with PCOS had hirsutism and 49.6% had acne. We recorded significantly higher serum levels of luteinizing hormone (LH), total testosterone (TT), free testosterone (fT) and insulin, while the serum levels of sex hormone binding globuline (SHBG) and follicular stimulating hormone (FSH) were significantly lower than in the control group. Serum glucose values were not significantly different between the groups. In conclusion, chronic anovulation, hirsutism and ultrasound appearance of polycystic ovaries are the dominant features of PCOS in Croatian population. The majority of patients with PCOS had normal body weight. The incidence of insulin resistance in this group of patients is less than the previously described frequency in other populations of patients with PCOS and normal weight.

[Correlations between clinical signs and hormonal parameters in young women with hirsutism]

Hyperandrogenism is the pathological condition, which clinical signs are "androgendependent dermopathies" (seborrhea, acne, hirsutism, alopecia) and not in every cases evidence with hyperandrogenemia. Free testosterone is the most frequent marker of hyperandrogenism, but its determination routinely not feasible in all laboratories. Therefore, some models for calculating free and bioavailable testosterone have been developed. In women the testosterone sources are not only ovaries and adrenal glands, but also abdominal and peripheral fat. There are many investigations to definite correlations between body mass index, androgens and sex hormone binding globulin. The aim of this study was to define the correlations between clinical, biochemical markers of hyperandrogenism and body mass index, with regard of abdominal obesity in young women with hirsutism. 83 female adolescents (14-20 year) with hirsutism and 20 female adolescents in control group were included. C-peptide, estradiol, total testosterone, sex hormone binding globulin (SHBG) were measured. Free androgen index (FAI), free (cFT) and bioavailable (Bio-T) testosterone were calculated. The levels of C-peptide and glucose were used to compute Homa-IR (homeostasis model assessment for insulin resistance). There were detected significant high levels by all hormonal parameters of hyperandrogenism in women with hirsutism, than in control group. In patients with abdominal obesity were also found significant high levels by all calculated parameters of hyperandrogenism and significant low level of steroid-bind globulin, than in patients with central obesity. In two groups by hirsutism degree were not detected any differences between androgen markers. The findigs of this research suggest, that android obesity in female adolescents with hirsutism can cause harder hyperandrogenism and elevate free androgen index, free and bioavailable testosterone levels. The prophylactic reduction of body mass index may prevent complications.

Androgenproduzierender Leydig-Zell-Tumor des Ovars als Ursache von Hirsutismus bei einer postmenopausalen Frau

BACKGROUND

Hirsutism or virilization in postmenopausal women may be due to increased testosterone levels caused by an androgen-secreting tumor. The preoperative localization of small ovarian or adrenal androgen-secreting tumors is difficult.

CASE REPORT

A 61-year-old, postmenopausal woman presented with progressive hirsutism and deepening of voice over the last 9 years. Serum testosterone was very high (almost 30 nmol/l). Computed tomographic (CT) scans of the adrenals and ultrasonography of the pelvis were negative. Selective catheterization and [(18)F]FDG-PET/CT investigation raised the suspicion of an androgen-secreting tumor of the right ovary. Oophorectomy was performed, and a Leydig cell tumor of the right ovary was confirmed on histological examination.

CONCLUSION

Selective catheterization and [(18)F]FDG-PET investigation may aid the detection of androgen-secreting tumors.

Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutism

Combined oral contraceptives (COCs) are considered the first-line treatment for women with hirsutism. They diminish androgen release from the ovary and decrease plasma free testosterone levels by increasing sex hormone-binding globulin (SHBG) concentrations. COCs containing cyproterone acetate (CPA) and drospirenone (DRSP) have been proved effective for the treatment of acne and facial hirsutism. This study prospectively compared the clinical and biochemical efficacy of 3 mg DRSP/30 microg ethinyl estradiol (EE) and 2 mg CPA/35 microg EE combinations in a total of 91 patients with hirsutism. Individuals randomly received a cyclic combination of either DRSP/EE (n=48) or CPA/EE (n=43) for 12 months. Basal serum total testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and SHBG levels, as well as Ferriman-Gallwey scores, were determined before and after treatment. Both COCs achieved a similar effect on clinical hirsutism scores, in addition to serum androgen and SHBG levels, after completion of therapy. The percentage reductions in total hirsutism score (median % (min-max)) during therapy were 0.70 (0-0.58) vs. 0.57 (0.10-1.00) at 6 months (p = 0.028) and 0.80 (0-0.42) vs. 0.81 (0-0.75) at 12 months (p = 0.6) in the DRSP/EE and CPA/EE groups, respectively. In conclusion, the DRSP/EE combination is at least as effective as the CPA/EE combination in improving hirsutism scores.

Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam’s criteria and women whose only clinical signs are oligo/anovulation or hirsutism

This study was an attempt to determine whether the hormonal and clinical profiles of polycystic ovarian syndrome (PCOS) or non-PCOS cases whose only admission signs were oligo/anovulation or hirsutism. This retrospective study comprised a total number of 118, age-matched, young Turkish women with initial admission signs and symptoms of menstrual disorders (MD) like oligo/anovulation or hirsutism. Of these, 66 cases were diagnosed as PCOS, based on 2003 Rotterdam criteria [presence of two of first three criteria such as oligo- and/or anovulation, signs of clinical hyperandrogenism (HA-c) and/or biochemical signs of hyperandrogenism (HA-b) and polycystic ovaries on ultrasonography after exclusion of specific identifiable disorders]. Fifty-two women were diagnosed as cases of oligo/anovulation or hirsutism before the era of PCOS Rotterdam's consensus criteria. These two PCOS and non-PCOS cases were evaluated in terms of body mass index (BMI), waist-to-hip ratio, serum FSH, LH, estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), androstendione (A) 17 hydroxyprogesterone (17-HP), fasting insulin, C-peptide levels, sex hormone-binding globulin (SHBG) and finally, ultrasonographic ovarian morphology. PCOS cases with unilateral and bilateral polycystic ovarian morphology on ultrasound scan were analyzed based on Rotterdam criteria. No statistically significant difference was detected among two groups, in terms of BMI, waist-to-hip ratio, serum FSH, LH, E2, fasting insulin, C-peptide levels (P > 0.05). However, blood levels of DHEAS, A and 17-HP were higher, whilst SHBG levels were remarkably lower (P = 0.008) in PCOS cases. Among PCOS group, hormonal and clinical characteristics did not differ, irrespective or uni- or bilaterality of ovarian morphology on ultrasonographic scan. Percentages of cases with androgenic alopecia, oily skin/acnea and increased ovarian volume were higher in PCOS group; whereas Ferriman-Gallwey score >/= 8 were similar between two groups. Total but not free testosterone remained high in PCOS group (P < 0.01). In both PCOS and non-PCOS cases, a linear correlation was apparent between BMI and insulin levels (r (s )= 0.69 and 0.32, P < 0.05, respectively). Among PCOS group, MD + HA-b + HA-c (n = 40) was present in 60.6% of subjects, MD + HA-b (n = 12) in 18.2%, and MD + HA-c (n = 14) in 21.2%. The three phenotypes did not differ in mean BMI, waist-to-hip ratio and biochemical characteristics. To conclude, non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.

Isolated scrotal hair in infancy

Nine male infants who developed scrotal hair with no other signs of virilization were evaluated. Median age for the development of scrotal hair was 4.5 months, and median age at presentation was 7.5 months. Endocrinologic investigations performed in 6 of the infants yielded normal findings. The scrotal hair receded at a mean age of 12 months, suggesting a transient benign event. The development of genital hair in boys under age 9 years is considered precocious, suggesting a possible pathological condition (eg, precocious puberty, congenital adrenal hyperplasia, adrenal or genital tumors), or may be due to premature adrenarche.

Efficacy of a new oral contraceptive containing drospirenone and ethinyl estradiol in the long-term treatment of hirsutism

OBJECTIVE

This study represents long term clinical and biochemical results and the response of different body parts to medical therapy with oral ethinyl estradiol/drospirenone combination in hirsute patients with or without polycystic ovary syndrome (PCOS).

DESIGN

Prospective, open, controlled clinical study.

SETTING

Outpatients at Erciyes University Medical School.

PATIENT(S)

Fifty women with moderate to severe hirsutism were recruited. Two women were lost to follow-up.

INTERVENTION(S)

Women were treated with 3 mg of drospirenone and 30 microg of ethinyl estradiol for 12 cycles.

MAIN OUTCOME MEASURE(S)

Hirsutism was assessed at 6-month intervals using the Ferriman-Gallwey (F-G) scoring system. Serum FSH, LH, total and free testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), estradiol (E2), and sex-hormone binding globulin (SHBG) levels at 6 and 12 months of therapy were compared with baseline values.

RESULT(S)

Total mean FG score declined by 67% and 78% after 6 and 12 months, respectively. Improvement was most prominent on the chest and abdomen, followed by the upper lip and chin. The lowest effect was observed on the back and arms. Serum levels of total and free T and A decreased, whereas SHBG levels increased significantly after 6 and 12 months when compared with baseline levels.

CONCLUSION(S)

Drospirenone/ethinyl estradiol combination exerts significant antiandrogenic activity and is effective in improving facial hirsutism. The beneficial effect is most obvious after six cycles and continues thereafter at a slower rate.

Female pattern hair loss, sebum excretion and the end-organ response to androgens

BACKGROUND

Although female pattern hair loss can be a feature of hyperandrogenism, many women with hair loss show no clinical or biochemical features of androgen excess. It is possible that hair loss in nonhyperandrogenic women is due to a high level of response to androgens by scalp hair follicles. In this study we explored this idea using sebum excretion as a marker of the cutaneous end-organ response to androgens.

OBJECTIVES

To test the hypothesis that hair loss in nonhyperandrogenic women is due to an increased cutaneous end-organ response to androgens.

METHODS

We studied 100 women, 41 with female pattern hair loss (without hirsutism), 29 with hirsutism (with and without scalp hair loss) and 30 subjects without hair problems. We measured hair density on the frontal scalp, forehead sebum excretion, serum free androgen index (FAI), and body mass index (BMI).

RESULTS

The mean FAI was significantly raised in hirsute women compared with nonhirsute women (P < 0.001), but there was no difference in FAI levels between nonhirsute women with and without hair loss. The mean BMI was also significantly elevated in hirsute women (P < 0.01) but there was no difference in BMI between nonhirsute women with and without hair loss. The mean sebum excretion was higher in hirsute women than nonhirsute women but the difference was not statistically significant. There was no difference in sebum excretion between nonhirsute women with and without hair loss. There was no correlation between hair density and sebum excretion.

CONCLUSIONS

Our results show that sebum excretion is not elevated in women with female pattern hair loss. This may indicate that different androgen-response pathways operate in controlling hair growth and sebum excretion. The alternative explanation is that nonandrogenic mechanisms are involved in mediating hair loss in some women.

Unusual adrenal cortical tumor of unknown biologic potential: a nodule in a nodule in a nodule

Adrenocortical tumors are uncommon neoplasms in childhood. Most pediatric adrenal tumors are virilizing and carcinomas are more common than adenomas. Recent molecular data suggest an adenoma-to-carcinoma progression sequence in adrenal cortical neoplasms. We report a case of a 5-year-old boy who presented with virilizing symptoms secondary to an adrenal tumor that was resected laparoscopically. The bulk of the tumor was a large, yellow mass with typical features of an adrenal cortical adenoma. In the center was a well-circumscribed tan-brown nodule that was distinct from the adenoma and had oncocytic features. A third minute focus (3.0 mm) was noted that was not circumscribed or encapsulated, but showed marked pleomorphism and abundant mitoses, including atypical forms and increased Ki67 compared with the outer 2 nodules. Molecular analysis to assess the clonality and mutation rates of the 3 distinct areas showed only 2 genetic loci with allelic imbalances.

Hair growth induced by diode laser treatment

BACKGROUND

Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment.

OBJECTIVE

To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. METHODS. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back.

RESULTS

Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site.

CONCLUSIONS

Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth.

Pilonidal sinus disease treated by depilation using an 800 nm diode laser and review of the literature

BACKGROUND

Pilonidal sinus disease is a debilitating, disfiguring chronic ailment that is often resistant to therapy. Its etiology and treatment remain in question.

OBJECTIVE

To assess the efficacy of an 800 nm diode laser in the treatment of recalcitrant pilonidal sinus disease.

METHODS

Two patients with recalcitrant pilonidal sinus disease were treated in the lower back, buttocks, and perigluteal cleft area with an 800 nm diode laser with a spot size of 9 x 9 mm, fluences of 30 to 48 J/cm2, and pulse widths of 15 to 24 milliseconds.

RESULTS

Long-term relief of pilonidal sinus disease was produced with as few as two treatments 2 months apart to as many as six treatments over a 2-year period. With each successive treatment, fewer pulses were needed and the interval between treatments increased.

CONCLUSION

The 800 nm diode laser may be an effective tool in the treatment of pilonidal sinus disease. By eliminating the source of hair and hair fragments that course along the surface of the lower back and buttocks, interruption of the etiologic source for pilonidal sinus disease can be accomplished.

Association between ovarian volume and serum insulin levels in ovulatory patients with idiopathic hirsutism

We assessed the influence of insulin on ovarian volume in 45 women with regular, ovulatory menstrual cycles, normal androgen levels, and isolated hirsutism (idiopathic hirsutism). Insulin levels, insulin-to-glucose ratio, and homeostasis model assessment (HOMA) were significantly higher in patients with ovarian volume >9 cm3 than in women with smaller ovaries (P<.05), and insulin levels presented a significant positive correlation with ovarian volume (r = 0.37, P=.02), which was independent of body mass index (BMI) or the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio.

Body hair scores and total hair diameters in healthy women in the Kirikkale Region of Turkey

It was aimed to determine the normal hair scores of women of Kirikkale region according to the Ferriman- Gallwey scale and to investigate the relationship between the hair shaft diameter and hair scores. Hair scores were calculated in 204 healthy women, and hair shaft diameters were measured from the hair samples collected from 60 patients. Body mass index, waist to hip ratio, insulin resistance and blood androgen levels were determined. Neutral, hormonal and total hair scores were 2.1 1.4, 3.1 2.7 and 5.2 3.6, respectively. The average total hair diameter and hormonal hair diameter were 191.93 90.49 m and 121.8 75.9 m respectively. The correlation between total hair diameter and total hair score was statistically significant (r=0.704 p 0.001). Also, the correlation between hormonal hair diameter and hormonal hair score was statistically significant (r=0.724 p 0.001). While hair scores and diameters show meaningful positive correlation with androgen levels, they show negative correlation with age. In our population, 95% value of total hair score was 11, and for the hormonal score, it was 9. Hair diameters increase with hair score, regardless of total or hormonal of hair scores. Hair scores and hair diameters may be affected by blood androgens in healthy women.

Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis

OBJECTIVE

To determine prevalence and clinical features of pituitary pars intermedia dysfunction (PPID) in horses with laminitis.

DESIGN

Case series.

ANIMALS

40 horses with laminitis.

PROCEDURES

Horses with laminitis that survived an initial episode of pain and were not receiving medications known to alter the hypothalamic-pituitary-adrenal axis were tested for PPID by evaluation of endogenous plasma ACTH concentration. Signalment, suspected cause, month of onset and duration of laminitis, Obel grade of lameness, pedal bone rotation, physical examination findings, results of endocrine function tests, treatment, outcome, and postmortem examination findings were recorded.

RESULTS

Prevalence of PPID as defined by a single high plasma ACTH concentration was 70%. Median age of horses suspected of having PPID (n = 28) was 15.5 years, and median age of horses without PPID (12) was 14.5 years. Laminitis occurred most frequently in horses with and without suspected PPID during September and May, respectively. Chronic laminitis was significantly more common in horses suspected of having PPID. In horses suspected of having PPID, the most common physical examination findings included abnormal body fat distribution, bulging supraorbital fossae, and hirsutism. Five horses suspected of having PPID had no clinical abnormalities other than laminitis. Seventeen horses suspected of having PPID that were treated with pergolide survived, and 3 horses that were not treated survived.

CONCLUSIONS AND CLINICAL RELEVANCE

Evidence of PPID is common among horses with laminitis in a primary-care ambulatory setting. Horses with laminitis may have PPID without other clinical signs commonly associated with the disease.

Low-dose (2.5 mg/day) finasteride treatment in hirsutism

This study was performed to confirm the therapeutic effects of low-dose, (2.5 mg/day) finasteride in hirsute women. Our study was a non-randomized prospective clinical trial. Twenty-nine patients with hirustism were included in the study. The patients received 2.5 mg finasteride once a day over a period of 12 months. Follicle stimulating hormone, luteinizing hormone, sex hormone binding globulin, 17 alpha-hydroxyprogesterone, estradiol, androstenedione, total and free testosterone, dehydroepiandrosterone sulfate levels and hirsutism scores were determined in all patients before treatment and at every 6 months during the therapy. The hirsutism score decreased from a mean of 18.4 +/- 4.6 to 8.4 +/- 4.2 during the study. The per cent reduction in hirsutism score (mean +/- SD) at 6 and 12 months was 29.2 +/- 14.5 and 55.7 +/- 14.9%, respectively. There were no significant differences in any of the hormone levels and no serious side-effects were observed during the treatment. In conclusion, low-dose finasteride (2.5 mg/day) is a cost-effective, well-tolerated therapeutic agent without significant abnormal biochemical findings and can be used in place of high-dose (5 mg/day) finasteride in the treatment of hirsutism.

Gene expression of type 2 17 beta hydroxysteroid dehydrogenase in scalp hairs of hirsute women

Androgens are the main hormonal regulators of human hair growth and they are related to clinical conditions such as hirsutism. The aim of this study was to analyze the gene expression of androgen receptor (AR) and type 2 17 beta hydroxysteroid dehydrogenase (17 beta-HSD) in keratinocytes of plucked scalp hairs from hirsute patients and normal subjects. We studied 58 women with hirsutism (31 with polycystic ovary syndrome (PCOS), 27 with idiopathic hirsutism (IH)); 15 control women; and 10 control men. Hirsutism was assessed by a modified Ferriman-Gallwey method. Hormonal status was assessed between days 2 and 10 of the menstrual cycle or on any day when the patients were amenorrheic. AR and type 2 17 beta-HSD mRNA levels were estimated by reverse transcription-polymerase chain reaction (RT-PCR). AR expression was similar in all groups. Type 2 17 beta-HSD gene expression in untreated hirsute patients was lower (2.1+/-0.10) than in normal women (3.1+/-0.17), and similar to men (1.8+/-0.22). Comparing hirsute patients, type 2 17 beta-HSD expression was higher in treated PCOS (3.0+/-0.34 versus 2.2+/-0.13) and IH patients (2.5+/-0.19 versus 2.0+/-0.15); hirsutism score was lower (P=0.003, PCOS; P=0.003, IH); and SHBG levels were higher (P=0.001, PCOS; P=0.024, IH) in treated patients. The free androgen index was lower in treated women (P=0.024 for the IH group). In conclusion, the lower expression of type 2 17 beta-HSD mRNA in scalp hairs of untreated hirsute patients suggests androgen metabolism disturbances with predominance of more potent androgens, as occurs in men. The enzyme's higher gene expression in treated hirsute patients could be an indirect evidence of restored enzyme activity and intracellular androgen metabolism.

Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism

OBJECTIVE

To compare second versus third generation combination oral contraceptives (OCs) in the treatment of hirsutism.

METHODS

Women with hirsutism, as defined by a minimum Ferriman-Gallwey score of 10, were randomized in a double-blind fashion to receive an OC containing either ethinyl estradiol/desogestrel or ethinyl estradiol/levonorgestrel for 9 months of treatment. Ferriman-Gallwey scores, androgen levels and sex hormone-binding globulin were measured at baseline and every 3 months for the duration of the study. Hormones were measured in duplicate by radioimmunoassay.

RESULTS

Of the 47 women enrolled, 24 were randomized to ethinyl estradiol/desogestrel and 23 were randomized to ethinyl estradiol/levonorgestrel. Mean sex hormone-binding globulin increased significantly in subjects using the desogestrel-containing contraceptive compared with the levonorgestrel-containing contraceptive. Ten subjects completed the 9 months of treatment in the levonorgestrel group and 11 completed the study in the desogestrel group. Mean free testosterone and 3alpha-androstanediol glucuronide decreased significantly in the group receiving ethinyl estradiol/desogestrel but not in the ethinyl estradiol/levonorgestrel group. Mean Ferriman-Gallwey scores decreased significantly in both treatment groups. Improvement in mean Ferriman-Gallwey score was 35.7 +/- 38.1% (p < 0.001) for the ethinyl estradiol/desogestrel arm and 33.4 +/- 27.3% (p < 0.001) for the ethinyl estradiol/levonorgestrel arm. There were no statistically significant differences found in the improvement of Ferriman-Gallwey scores between the two treatment arms, although the power to detect a difference was limited by the small sample size.

CONCLUSIONS

Treatment of hirsute women with third generation OCs containing desogestrel results in a significant increase in sex hormone-binding globulin and decrease in free testosterone and 3alpha-androstanediol glucuronide. Both second and third generation OCs were clinically effective in treating hirsutism.

Comparison of the clinical efficacy and safety of flutamide versus flutamide plus an oral contraceptive in the treatment of hirsutism

OBJECTIVE

To compare the clinical, hormonal, biochemical and hemotological effects of flutamide versus flutamide plus an oral contraceptive (OC) in the treatment of hirsutism.

PATIENTS

Eighty-four women with hirsutism were equally randomized to receive either flutamide or flutamide plus OC.

DESIGN

Eighty-four women with hirsutism were recruited from patients presenting to our hospital. Each patient underwent a complete medical and gynecological examination as well as blood cell counts, biochemical and endocrine profiles. Hirsutism scores and laboratory tests were done during the 1st, 3rd and 6th months of therapy. Thirty-seven women in the flutamide group (taking 250 mg flutamide per day) and 32 women in the flutamide plus OC group (taking 250 mg flutamide plus 35 microg ethinyl estradiol and 2 mg cyproterone acetate per day) regularly followed the therapy regimens.

RESULTS

There were no significant differences in Ferriman-Gallway scores at the beginning and at the end of the therapies between the two groups (p > 0.05). At the 6th month, the decreases in Ferriman-Gallway scores were significant in both flutamide (from 18.95 +/- 4.44 to 14.46 +/- 5.02; p < 0.05) and flutamide plus OC groups (from 19.94 +/- 4.31 to 15.58 +/- 4.28; p < 0.05). In the first group, 2 of 6 oligomenorrheic women had regular cycles at the end of the therapy. Oligomenorrhea in 8 women was all changed to regular cycles in the flutamide plus OC group. Regarding the hormonal profile, only in the second group were prolactin, free testosterone and dehydroepiandrosterone sulfate levels significantly decreased (p < 0.05). Hepatic function tests were significantly increased in both groups, but they were all within normal ranges.

CONCLUSION

These data suggest that both therapies were similarly effective and safe in the treatment of hirsutism. In women with oligomenorrhea and/or needing contraception, adding an OC shows better results than flutamide treatment alone in providing regular cycles.

Androgenetic alopecia in a postmenopausal woman as a result of ovarian hyperthecosis

A 65-year-old woman presented with an 8-year history of progressive frontotemporal alopecia and hirsutism. She had elevated serum levels of testosterone, androstenedione and estradiol. Ultrasound and computed tomography imaging suggested a right ovarian mass, while bilateral ovarian venous sampling demonstrated increased testosterone levels originating from both ovarian veins. Histology obtained following bilateral oophorectomy demonstrated bilateral ovarian hyperthecosis. Six months after surgery, the patient remains well with no progression of the alopecia. Ovarian hyperthecosis is a rare cause of androgenetic alopecia in postmenopausal women. The role of hyperthecosis and its relationship to androgenetic alopecia is reviewed.

Antihirsutism activity of Fennel (fruits of Foeniculum vulgare) extract. A double-blind placebo controlled study

Idiopathic hirsutism is defined as the occurrence of excessive male pattern hair growth in women who have a normal ovulatory menstrual cycle and normal levels of serum androgens. It may be a disorder of peripheral androgen metabolism. In this study we evaluated the clinical response of idiopathic hirsutism to topical Fennel extract. Fennel, Foeniculum vulgare, is a plant, which has been used as an estrogenic agent. The ethanolic extract of Fennel was obtained by using a soxhlete apparatus. In a double blind study, 38 patients were treated with creams containing 1%, 2% of Fennel extract and placebo. Hair diameter was measured and rate of growth was considered. The efficacy of treatment with the cream containing 2% Fennel is better than the cream containing 1% Fennel and these two were more potent than placebo. The mean values of hair diameter reduction was 7.8%, 18.3% and -0.5% for patients receiving the creams containing 1%, 2% and 0% (placebo) respectively.

Hormonal profile of women with self-reported symptoms of oligomenorrhea and/or hirsutism: Northern Finland birth cohort 1966 study

The hormonal profiles of nested female patients (n = 500) with self-reported symptoms typical of polycystic ovary syndrome (PCOS), oligomenorrhea, and/or hirsutism and their randomly selected controls (n = 1026) at the age of 31 yr were analyzed in a general population-based Northern Finland birth cohort 1966 to find out whether the symptomatic women also have the endocrine characteristics of PCOS and could be detected in a general population using simple questions. Higher medians of serum testosterone (T) (2.10 vs. 1.90 nmol/liter, P < 0.001), LH (5.40 vs. 4.85 U/liter, P = 0.005), insulin (53.8 vs. 51.66 pmol/liter, P = 0.040), and free androgen index (FAI) (4.01 vs. 3.03, P < 0.001) and lower glucose/insulin ratio (91.1 x 10(8) vs. 94.9 x 10(8), P = 0.048) and SHBG (52.4 vs. 60.7 nmol/liter, P < 0.001) were observed among the cases, but no difference was observed in cortisol and glucose levels between the cases and controls. Of all the women in the cohort, 10.2% reported only oligomenorrhea and had biochemical findings similar to the whole case group. Those who reported only hirsutism (10.4%) were in between the case and control groups according to biochemical findings. The subjects who reported both oligomenorrhea and hirsutism (3.4%) had the highest T, LH, FAI, insulin, and glucose and the lowest SHBG and glucose/insulin ratio, compared with the case group and the groups with either symptom only indicating a dose-response manner in typical endocrine profile of PCOS by adding up symptoms. The levels of T and FAI were higher and SHBG lower in groups with overweight or obesity both at 14 and 31 yr, compared with groups with normal weight at 14 yr and overweight or obesity at 31 yr. In the group with normal weight at 14 and 31 yr and the group with overweight or obesity at 14 yr but normal weight at 31 yr, the levels of T and FAI were lowest and SHBG highest. T and FAI were higher and SHBG lower among the cases than the controls in groups stratified by weight development from adolescence to adulthood. In conclusion, this longitudinal study of a large, stable population indicates that women with self-reported symptoms of hirsutism and/or oligomenorrhea show endocrine characteristics of PCOS and can be detected in a general population using simple questions. These symptoms are markers of the underlying metabolic alterations possibly associated with increased health risks in later life.

The Diagnosis and Management of Hirsutism

Approximately 10% of women of childbearing age are hirsute, which is defined as the presence of coarse terminal hairs in androgen-dependent areas on the face and body. It not only is a source of psychological discomfort but also may be a sign of an underlying medical condition. This article reviews the pathophysiology, diagnosis, evaluation, and treatment of hirsutism.

Side-effects after IPL photodepilation

BACKGROUND

Intense pulsed light (IPL) has been successfully used as an efficient hair removal system; however, possible side-effects have been not specifically addressed in the literature.

OBJECTIVE

To assess all possible side-effects after IPL hair removal in a series of 49 females with facial hirsutism during a total of 390 treatment sessions of IPL photodepilation.

METHODS

Immediate post-treatment clinical, photography evaluation, and a two-month post-treatment questionnaire were done in 49 females with facial hirsutism submitted to photodepilation with an IPL source (EpiLight trade mark, ESC, Israel).

RESULTS

Side-effects observed were: transient erythema (n = 30), late evanescent erythema (n = 3), mild pain (n = 43), moderate pain (n = 6), crust formation (n = 9), superficial burning (n = 1), isolated vesicles (n = 3), transient hyperpigmentation (n = 8), transient hypopigmentation (n = 1), paradoxical effect (n = 5), persistent local heat sensation (n = 1), and minimal scar (n = 1).

CONCLUSION

Even though common, most side-effects secondary to IPL photodepilation are mild and transient. Permanent side-effects such as scars are unlikely but they may occur. Growth of new, fine and dark hair may be seen in untreated areas in close proximity to the treatment area, especially in the neck, a side-effect that is reported for the first time in the literature.

Paradoxical effect after IPL photoepilation

BACKGROUND

Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects.

OBJECTIVE

To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect").

METHODS

A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study.

RESULTS

A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment.

CONCLUSION

IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.

Acne resolution rates: results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara) and EE/LNG (Microgynon)

BACKGROUND AND OBJECTIVE

Acne in women can often be successfully treated by the intake of oral contraceptives containing gestagens with anti-androgenic properties. This study aimed to evaluate the efficacy of the monophasic oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA; Belara for the treatment of mild to moderate papulopustular acne of the face and acne-related disorders in comparison to EE/levonorgestrel (LNG; Microgynon.

METHODS

199 female acne patients were enrolled in a single-blind, randomized, multicentre phase III study and divided into two groups who received either EE/CMA or EE/LNG. The primary end point was fulfilled if the number of papules/pustules per half of the face present on admission had decreased by at least 50% in the 12th medication cycle.

RESULTS

59.4% of the women under EE/CMA and 45.9% under EE/LNG were responders. The relative frequency of women with complete resolution was 16.5% under EE/CMA and 4.3% under EE/LNG at cycle 12.

CONCLUSION

EE/CMA is an efficient treatment for women with mild and moderate papulopustular acne of the face and related disorders, reflecting the well-known anti-androgenic properties of the progestogen CMA.

Hair and systemic disease

Hair loss (alopecia) occurs as a manifestation of numerous systemic diseases, but usually can be categorized into one of five general groups: telogen effluvium, anagen arrest, follicular destruction, hair miniaturization, and hair shaft defects. An excess of hair also can be evidence of internal disease, and there are two general categories of increased hair density: hypertrichosis and hirsutism. The basic categories of hair disease and the systemic conditions associated with them are discussed. The history, physical examination, and histopathologic data usually are sufficient to categorize the form of hair disorder and may provide a clue to the nature of the underlying systemic disease.

Silver-Russell syndrome associated to Mayer-Rokitansky-Kuster-Hauser syndrome, diabetes and hirsutism

We report an unusual association of two rare conditions, the Silver-Russell syndrome and the Mayer-Rokitansky-Küster-Hauser syndrome, with extra endocrine anomalies. A 15-year old Silver-Russell syndrome girl was referred to our Unit because of primary amenorrhea and hirsutism of adrenal origin. A thorough assessment confirmed previous diagnoses and revealed the presence of diabetes, hyperinsulinism and a complete Mayer-Rokitansky-Küster-Hauser syndrome with an ectopic localization of both ovaries. Although initial medical treatment was not unsatisfactory, future medical, psychological and social implications are expected.

Androgen suppression and clinical improvement with dopamine agonists in hyperandrogenic-hyperprolactinemic women

OBJECTIVE

To examine the effect of dopamine agonist (DA) treatment on clinical and biochemical features in hirsute, hyperprolactinemic (HPRL) women and the relationship between prolactin (PRL) and androgens.

STUDY DESIGN

We evaluated 80 hirsute HPRL women (age, 27 +/- 1 years [mean +/- SE]) with neuroleptic treatment, prolactinoma and idiopathic HPRL (12, 13 and 55, respectively). DA, mainly bromocriptine, was administered for 11 +/- 1 months. Response indicators were Ferriman-Gallwey hirsutism (FGS) and Leeds acne (LAS) scores, circulating PRL, dehydroepiandrosterone sulfate (DHEAS), free and total testosterone, and androstenedione.

RESULTS

Baseline PRL correlated positively with DHEAS (r = .23, P = .03) and free testosterone (r = .36, P < .001). In all women, FGS, LAS, PRL, free testosterone, DHEAS and androstenedione decreased by 40-85% during DA treatment (P < .001). The decline in free testosterone was higher when PRL was > or = 65 ng/mL than when PRL was < 65 (P = .03) and correlated positively with basal DHEAS (r = .40, P < .001).

CONCLUSION

Our data suggest a modulation by PRL of adrenal androgen production. DA treatment reduces PRL and serum androgens. It results in a significant clinical improvement in acne and hirsutism. Therefore, DA is recommended as monotherapy for hyperandrogenic.

Hirsutism of adrenal origin in adolescents: consequences in adults

Hirsutism is a common clinical and psychological problem in women. Polycystic ovary syndrome and idiopathic hirsutism are the most common causes of hirsutism. Adrenal disorders are less common causes of hirsutism; the most common adrenal cause of hirsutism is non-classical congenital adrenal hyperplasia (NC-CAH). Hirsutism may be the presenting symptom of an adrenal carcinoma or adenoma. In this review, adrenal causes of hirsutism, the pathophysiology of the hirsutism in NC-CAH, and the treatment of hirsutism in these patients, are discussed.

Syndrome of gingival hypertrophy, hirsutism, mental retardation and brachymetacarpia in two sisters: specific entity or variant of a described condition?

Two sisters born to consanguineous Lebanese parents had mental retardation and epilepsy, brachymetacarpalia, hirsutism, bulbous soft nose, thick floppy ears with abnormal configuration and gingival hypertrophy. One girl presented additionally with tetralogy of Fallot and the other with congenital hypothyroidism and bilateral ureteral stenosis. These manifestations resemble the syndrome of hypertrichosis-gingival fibromatosis-mental retardation and seizures of Anavi et al. [1989: Dev Med Child Neurol 31:538-542] but our two girls additionally have brachymetacarpia. The inheritance seems to be autosomal recessive. These two sisters may represent a hitherto undescribed syndrome. We discuss the findings in our patients in relation to the literature.

Polythelia pilosa: a particular form of accessory mammary tissue

BACKGROUND

The old Kajawa classification which considered eight possible forms of aberrant mammary tissue has been recently modified into a simpler one that considers this condition only when there is glandular parenchyma or when the aberrant tissue is not a glandular tissue but a nipple, an areola or both. This new classification disregards 'polythelia pilosa' defined as an 'isolated patch of hairs only'.

OBJECTIVE

To demonstrate that polythelia pilosa is at least a marker of subjacent accessory mammary tissue and, consequently, that the term should be incorporated into the current classification.

METHODS

Among 72 cases of aberrant or accessory mammary tissue, we have studied 14 cases (7 men and 7 women) that were clinically diagnosed as 'visible isolated patches of hairs, apparently without pigmentation nor structures of areola or nipple'. We excised such isolated patches in 3 women.

RESULTS

The histopathological examination showed an acanthotic and hyperpigmented epithelium with central depression closed by keratin plugs; in the dermis there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type could be observed.

CONCLUSION

Since the biopsy of isolated patches of hairs demonstrated structures of either areolar or apocrine glandular tissue, we think that the term 'polythelia pilosa' should be reinstated into the classification as it is at least a marker of true aberrant mammary structures in men and hirsute women.

Sibs with developmental delay, hirsutism and nail hypoplasia: a new syndrome

A sister and brother with developmental delay, hirsutism and variable nail hypoplasia are described. The facial features of these sibs are striking. We postulate that this represents a new syndrome, the inheritance of which is unknown.

The best correlation of the new index of hyperandrogenism with the grade of increased body hair

OBJECTIVE

Hyperandrogenemia is the most frequent endocrine disorder in fertile women causing a variety of negative metabolic disturbances. Establishing the diagnosis of androgen overproduction has important implications for the follow-up and treatment of patients. The aim of our study was to identify the optimal laboratory marker of androgen production by correlating the markers to the presence or grade of increased body hair as a clinical sign of hyperandrogenism.

DESIGN

Prospective observational study.

METHODS

A total of 62 women with acne were included into the study. The serum concentrations of testosterone, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS) and sex hormone-binding globulin (SHBG) were evaluated. The index of free testosterone (IFT) and a new index of hyperandrogenism (IHA) were calculated. The monitored laboratory markers were correlated to the presence or grade of increased body hair using several statistical methods.

RESULTS

The statistical significance of differences between the average levels of laboratory markers between hirsute and non-hirsute women decreased in the following order: IHA, androstenedione and DHEA. Of all the above laboratory markers, only increased IHA was present significantly more often in hirsute women. The significance of correlation between the grade of increased body hair and the tested variables decreased in the following order: IHA, IFT, DHEA, androstenedione, DHEAS and testosterone.

CONCLUSIONS

The clinical marker of hyperandrogenism correlates most closely to IHA, reflecting the levels of all commonly determined androgens or androgen precursors and SHBG. Its simple calculation makes IHA a suitable tool for determining total production of androgens in clinical practice, especially in cases with borderline elevations of values.

Serum prostate-specific antigen concentrations are not useful for monitoring the treatment of hirsutism with oral contraceptive pills

Prostate-specific antigen (PSA) is produced in several female tissues, under the regulation of steroid hormones. Serum PSA levels are increased in women with hirsutism, and they correlate with serum androgen levels. Therefore, as a marker of androgen excess, measurement of serum PSA may play a role in monitoring the treatment of hirsutism with contraceptive pills. Sixteen hirsute patients were included in the study. Clinical and biochemical variables, including serum PSA (using an ultrasensitive chemiluminescent immunoassay), total testosterone, sex hormone-binding globulin, androstenedione, dehydroepiandrosterone-sulfate, estradiol, and gonadotropin concentrations were recorded at baseline and after 3 and 6 cycles of treatment with a monophasic contraceptive pill containing ethynylestradiol and desogestrel. Twenty-seven healthy women served as controls for serum PSA level and for the serum androgen profile. Serum PSA levels were higher in hirsute patients, as compared with healthy women (mean +/- SEM: 0.014 +/- 0.003 vs. 0.006 +/- 0.001 microg/L, P < 0.02). Despite a marked decrease in serum androgens (total testosterone and androstenedione, calculated free testosterone and free androgen index; and dehydroepiandrosterone-sulfate) and in the hirsutism score, and a marked increase in sex hormone-binding globulin levels, serum PSA levels did not change and remained detectable in all the hirsute patients after 3 and 6 cycles of treatment with contraceptive pills. In conclusion, the increased serum PSA levels present in hirsute patients do not change during treatment with contraceptive pills and do not parallel the amelioration in hirsutism and the decrease in serum androgen concentrations that occur during this treatment. Thus, serum PSA measurements have no apparent role in the management of hirsute patients on oral contraceptive treatment, at least with the ultrasensitive assays currently available.

Hair removal in 40 hirsute women with an intense laser-like light source

Until recently, previously applied methods to remove hair have ultimately proven ineffective or resulted in the formation of scars and small wounds. Different methods for removing hair in a more or less permanent way have been used: electrolysis, thermolysis and the blend method. In this study we describe the removal of hair without side-effects by means of non-laser incoherent emitted light, produced by the ILS flashlamp. In a multicenter study we treated 40 women with a median age of 38.6 years with hirsute hair growth of different hair colours on the upper lip and chin. In general 76.7% of the hair was removed within 6 treatments, with an average fluence of 38.7 J/cm2 and a mean wavelength of 585 nm per patient. A correlation was found between the percentage reduction of hairs and the number of treatments and between hair removal and needle epilation before treatment. Furthermore, a correlation was seen between hair reduction and wavelengths of 570 nm and 550 nm. No association was found between hair removal and clinical data of the patients, nor between hair reduction and technical data of the device. This study presents a new alternative for hair removal.