Hyperandrogenism, Insulin Resistance, and Acanthosis Nigricans (HAIR-AN) Syndrome Reflects Adipose Tissue Dysfunction (“Adiposopathy” or “Sick Fat”) in Asian Indian Girls

Abstract

<b><i>Background:</i></b> Whether HAIR-AN syndrome and polycystic ovarian syndrome (PCOS) are distinct entities or represent a phenotypic spectrum of the same syndrome is still unclear. HAIR-AN syndrome is characterized by high insulin resistance, obesity, and hyperinsulinemia as compared to PCOS and could represent adipose tissue dysfunction as the primary pathophysiologic trigger. This study was undertaken to study the role of adipose tissue dysfunction in HAIR-AN syndrome and PCOS using adipocytokines as surrogate markers of “adiposopathy.” <b><i>Materials and Methods:</i></b> A cross-sectional observational study was conducted at a tertiary care hospital over a period of 1 year. Serum adiponectin, leptin, IL-6, and TNF-α levels were measured in 30 women with HAIR-AN syndrome and in 30 women with PCOS. Correlations between adipocytokines, inflammatory markers, serum testosterone, and serum insulin were determined. Data analysis was performed using the SPSS version 23.0 (IBM SPSS Statistics Inc., Chicago, IL, USA) software program. <b><i>Results:</i></b> Women with HAIR-AN syndrome had significantly higher hyperandrogenemia, hyperinsulinemia, and insulin resistance as compared to PCOS women. They also had high leptin levels and lower adiponectin levels (<i>p</i> < 0.001). However, the levels of inflammatory markers (TNF-α and IL-6) were similar in both the groups (<i>p</i> > 0.05). Serum adiponectin showed a negative correlation with HOMA-IR and testosterone levels, while leptin showed a positive correlation with both in HAIR-AN patients while no such correlation was found in the PCOS group. <b><i>Conclusion:</i></b> The significantly raised adipocytokines in HAIR-AN syndrome patients as compared to PCOS patients indicates the primary role of adipose tissue dysfunction (“adiposopathy”) in the pathogenesis of HAIR-AN syndrome while only a minor role, if any, in PCOS. Both these syndromes stand as distinct entities pathogenically with an overlapping phenotype.

A Rare Case of Adolescent Girl with Beard-PCOS with a Difference: “HAIR-AN Syndrome”

“…The HAIR-AN syndrome, which is a sub-phenotype of PCOS, has a similar presentation to PCOS but with more prominent HA and AN. Although oligomenorrhea and polycystic ovarian morphology are not diagnostic features of the HAIR-AN syndrome, they were found in 40% of patients with the overlap syndrome [6]. Our patient presented with features of PCOS with severe IR.…”

Acanthosis Nigricans in Adolescents versus Adults; Association with Obesity, Diabetes and Hypertension

“…6, Regarding types of AN, out of 114, Benign AN was found in 111(97.4%), the most common type in our study which is followed by HAIR-AN syndrome (includes high insulin resistance, obesity and hyperinsulinemia). 23 Benign type is the indicator for IR secondary to obesity. 24 We found HAIR-AN syndrome, the 2 nd most common type 61(53.5%) in which 32(56.1%) were adolescents and 29(50.9%) adults (p=0.573).…”

The role of the thyroid in polycystic ovary syndrome

“…All insulin level reduction treatments have been shown to improve ovarian dysfunction and ovulation ( 57 , 91 , 92 ). Significant insulin resistance is believed to be associated with hyperandrogenism and acanthosis nigricans ( 93 ). The compensatory hyperinsulinemia of insulin resistance may allow the ovaries to partially escape LH desensitization, resulting in increased responsiveness of ovarian steroids to LH ( 94 , 95 ).…”