Published in:
01-10-2020 | Hirsutism | Original Article
Is Idiopathic Hirsutism Truly Idiopathic?
Published in: The Journal of Obstetrics and Gynecology of India | Issue 5/2020
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Objective
To determine whether other androgens [androstenedione (A4), 17-hydroxy progesterone (17OHP) and dehydroepiandrosterone (DHEA)] were elevated in women with classically defined idiopathic hirsutism (IH)/patient-important hirsutism (PIH).
Study Design
Retrospective analysis.
Setting
Outpatient endocrine department of a tertiary care hospital.
Patients
In total, 30 consecutive women with IH/PIH were included. IH/PIH was defined as presentation with hirsutism with normal menstrual cycles (25–35 days), normal total (< 45 ng/dL) and free T (fT) (< 0.6 ng/dL) and normal ovaries sonologically (transabdominal ultrasonogram ovarian volume < 10 cm3) without any other signs of virilization. Clinical and biochemical details were collected and analyzed. Androgens were measured by LC–MS/MS. A4 ≥ 2.5 ng/mL, DHEA ≥ 15 (age < 18) or ≥ 11.8 (age ≥ 18) ng/mL, DHEAS ≥ 2847 ng/mL or 17OHP ≥ 2 ng/mL were considered high.
Results
With the mean age of 22 years and mean BMI of 25 kg/m2, 12/30 (40%) had IH and remaining PIH. DHEA alone was elevated in 60% and A4 alone in 33%. Overall, 23/30 (73%) had any one elevated androgen with normal total and free testosterone. There was no correlation with modified Ferriman–Gallwey score, and there was no significant difference in androgens between IH and PIH.
Conclusion
A high proportion of women with classically defined IH/PIH have elevated DHEA and/or A4. Though on pharmacotherapy basis, there would be no change in management, the role of hyperandrogenemia detected by sensitive assays on metabolic functions and cardiovascular risk has to be studied.