The Investigation of Insulin Resistance in Patients with Idiopathic Hirsutism

Abstract

2 ) were included in the study. Eight of 32 patients with IH had BMI higher than 30 kg/m 2 . The presence of insulin resistance was investigated by using basal insulin levels, the oral glucose tolerance test, the iv insulin tolerance test, and the homeostasis model assessment (HOMA) score in both groups. Six (18.7%) patients had impaired glucose tolerance (IGT). Overall, patients with IH had significantly (P < 0.05) higher basal insulin levels (10.5 ؎ 1.1 mU/liter vs. 5.7 ؎ 0.9 mU/liter) and HOMA scores (2.0 ؎ 0.2 vs. 1.1 ؎ 0.2) and lower plasma glucose disappearance rate values (5.2 ؎ 0.2 vs. 6.0 ؎ 0.3) than control subjects. However, patients with IGT were notably more obese than the patients with a normal glucose tolerance test. Analyses after omitting the patients with IGT showed that there was still a significant (P < 0.05) difference in terms of basal insulin levels and HOMA scores. Six of eight (75%) obese patients with IH showed IGT. These data suggest that IH is associated with insulin resistance and an increased prevalence of IGT in obese patients. (J Clin Endocrinol Metab 89: 2741-2744, 2004) H IRSUTISM, WHICH IS characterized by excessive growth of terminal hair in a male pattern, is a common clinical condition in women (1). It may result from various causes including polycystic ovary syndrome (PCOS), nonclassic adrenal hyperplasia, adrenal or ovarian tumors, or it may be idiopathic. Idiopathic hirsutism (IH) is considered to be one of the most common forms of hirsutism (2, 3). 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 (4).The pathogenesis of IH is not clear. Increased peripheral 5␣-reductase activity (5) and androgen receptor gene polymorphisms (6, 7) have been postulated to explain the pathogenesis of this disorder. Insulin resistance and hyperinsulinemia are now well known features of PCOS, and insulin-sensitizer drugs improve the hirsutism in patients with PCOS, however, there are not enough data whether patients with IH also have insulin resistance. Thus, our aim was to investigate the presence/absence of insulin resistance and hyperinsulinemia in women with IH. Patients and MethodsThirty-two women with IH and 17 healthy women were included in the study. None of the control subjects had ovarian dysfunction, hirsutism, or hyperandrogenemia. The purpose of the protocol was explained both to the patients and control subjects, and informed consent was obtained before beginning the study. The subjects were recruited sequentially from the clinic practice. The study was approved by the local Ethics Committee.The diagnosis of IH was based on the presence of hirsutism (modified Ferriman-Gallwey score, Ͼ8) (8), regular ovulatory menstrual...

Evaluation of various insulin sensitivity indices in lean idiopathic hirsutism patients

“…Unluhizarci et al [20] did not choose especially lean patients for their study. BMI was not an exclusion crite-…”

“…Unluhizarci et al [20] showed that IH is associated with some degree of insulin resistance and increased tendency for glucose intolerance notably in obese women with IH.…”

Investigation of adrenal functions in patients with idiopathic hyperandrogenemia

“…We have also shown an increased prevalence of glucose intolerance in women with idiopathic hirsutism, who actually have normal serum androgen levels (12). From another point of view it has been shown that hyperinsulinemia during OGTT might activate the androgen pathway of the adrenal cortex (18).…”

“…On the other hand, a number of androgen excess disorders are diagnosed by exclusion such as PCOS. Although hirsutism is the most common feature of androgen excess, it is well known that not all patients with hirsutism have overt androgen excess as in idiopathic hirsutism (12,13). We have previously shown that a number of patients with hirsutism had hyperandrogenemia with normal ovaries and regular cycles.…”

Resistência insulínica e perfil metabólico em pacientes com síndrome dos ovários policísticos de peso normal e sobrepeso/obesidade

“…No entanto, é extremamente laborioso e caro, sendo inexequível da prática, na maioria dos serviços (6). Por isso, tem-se aferido a sensibilidade insulínica através de métodos mais simples, como o teste oral de tolerância à glicose com a dosagem de insulina (TOTG), o cálcu-lo da relação glicose/insulina (G/I), a insulinemia de jejum ou basal (IB) e pós-prandial, além do homeostatic model assessment (HOMA) (4,(7)(8)(9).…”