Prevalence and biochemical characterization of hirsutism-associated syndromes in a cohort of Portuguese women

Abstract

Context: Hirsutism is a symptom of hyperandrogenism mostly associated with polycystic ovary syndrome (PCOS), idiopathic hirsutism (IH), and non-classic congenital adrenal hyperplasia (NCCAH). Hirsutism is associated with metabolic dysfunction. Objective: Estimate the prevalence of PCOS, IH, and NCCAH among Portuguese hirsute women and characterize their hirsutism score and hormonal and metabolic profile. Design: Cross-sectional. Setting: Tertiary care academic medical centre. Patients: Data from 566 hirsute patients was collected. Case files from women below 16 years old, on oral contraceptives, or with other endocrine disorders were excluded. Control subjects were non-hirsute eumenorrheic women not on oral contraceptives. Main outcome measures: Hirsutism was evaluated by the modified Ferriman-Gallwey score. Biochemistry analysis included total and free testosterone, androstenedione, DHEA, DHEAS, SHBG, progesterone, FSH, LH, and fasting glucose and insulin levels. Indexes evaluated were free androgen index (FAI), LH/FSH ratio, homeostatic model assessment for insulin resistance and body mass index. Results: Amongst hirsute women, 52% had PCOS, 23% had IH and 6% had NCCAH. PCOS patients were younger, more hyperandrogenic and had more metabolic dysfunction than controls. IH patients were also younger, presented metabolic dysfunction and had increased FAI, despite normal androgenemia. NCCAH patients had the highest androgen levels, and excluding higher insulinemia and overweightness, metabolic dysfunction was not conspicuous. In all diseases hyperandrogenism correlated with metabolic dysfunction. Conclusion: Hyperandrogenism is associated with metabolic dysfunction, which is of the utmost importance in the clinical approach to the management of hirsute women. This is the first Portuguese study of its kind, but more studies are needed to enhance the knowledge on major hirsutism-associated syndromes.