We report the case of a 61-year-old Filipino woman with postmenopausal virilization presenting with androgenic alopecia, progressive hirsutism and deepening voice over 5 years due to elevated testosterone levels. Ultrasound and computed tomography imaging suggested a left adnexal mass. Histology obtained following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) demonstrated stromal luteoma of the left ovary. On immunohistochemistry, the tumor was positive for inhibin. Postoperatively, there was note of rapid normalization of testosterone level.
Hyperandrogenism

A 37-year old primigravid with HAIR-AN syndrome on Metformin therapy achieved spontaneous pregnancy after fifteen years of infertility.
Human ; Female ; Adult ; HAIR-AN SYNDROME ; HYPERINSULINISM ; HYPERANDROGENISM

This is a case report of M.C. a 32 year-old G3P2 (2001), who was admitted to the labor room of a tertiary government hospital for labor pains and watery vaginal discharge. The working impression at the time of admission was: Pregnancy uterine thirty-nine (39) weeks age of gestation by amenorrhea cephalic in labor, poor obstetric history for two full term deliveries with congenital anomaly. Patient is well with no medical co-morbidities. Her family and past medical histories were unremarkable. She previously delivered her two older children vaginally. Both of whom were later diagnosed with congenital adrenal hyperplasia (CAH) from newborn screening and manifestations of the external genitalia. Congenital adrenal hyperplasia can be identified as early as six weeks age of gestation by doing karyotyping following chorionic villus sampling or the less invasive fetal sex determination using the maternal plasma. The optimum time to conduct these tests is between six to eleven weeks age of gestation. At this juncture, embryogenesis of the external genitalia is completed. Unfortunately, the mother`s prenatal course began at seventeen weeks age of gestation thus a diagnosis of CAH for this pregnancy is inconclusive. After six hours of labor, she delivered to a live baby girl who on physical inspection of the genitalia appeared to be grossly normal at that time. She was directly roomed in. Newborn screening was done. With an unremarkable hospital stay, both mother and child were discharged. Follow-up at two weeks post patrum, the neonate presented with clitoromegaly and newborn screening came out positive for CAH.
Human ; Female ; Adult ; ADRENAL HYPERPLASIA, CONGENITAL ; HYPERANDROGENISM

BACKGROUND

Polycystic ovarian syndrome (PCOS) is a common gynecologic endocrine disorder affecting between 2.2% and 26% of the population. It is typically characterized by hirsutism and signs of ovulatory dysfunction. Hirsutism is defined as the presence of excess body or facial terminal hair growth in females, following a male-like pattern. It is diagnosed using visual assessment methods, such as the modified Ferriman–Gallwey (mFG) scoring system, and biochemical tests, including measurements of total testosterone (tT) and the free androgen index (FAI).

The general objective of the study is to identify the correlation of visual scoring with the biochemical evaluation of hirsutism. Specific objectives include (1) to describe the visual and biochemical scores of hirsutism in PCOS patients and (2) to determine a cutoff score for the visual scoring of hirsutism among Filipinos.

This is a cross-sectional study done in a tertiary hospital. Ethical approval was obtained for this study. Patients who satisfied the inclusion criteria were included in the study. Age, height, weight, body mass index (BMI), and OB score were noted. Visual scoring for hirsutism using the mFG scoring system was performed. Blood extraction was done for testosterone and sex hormone-binding globulin tests. FAI was then computed and correlated with the mFG scores.

A total of 52 patients were identified. A positive correlation is noted between the mFG with testosterone and FAI. A positive correlation was also noted between the BMI with testosterone and FAI. An mFG value of >4 is an acceptable cutoff for Filipinos.

The study showed as the mFG score increases, FAI and tT levels also increase. It was also noted that as BMI increases, the FAI and tT levels are also expected to increase. It can also be concluded that a lower mFG cutoff value, >4, is applicable for Filipinos.

No abstract available.
Acanthosis Nigricans* ; Hyperandrogenism* ; Insulin Resistance* ; Insulin* ; Proliferating Cell Nuclear Antigen*

No abstract available.
Acanthosis Nigricans* ; Hyperandrogenism* ; Insulin Resistance* ; Insulin* ; Proliferating Cell Nuclear Antigen*

To determine the (tttta)n repeat polymorphisms at the promoter region of CYP11alpha gene, and study its linkage to hyperandrogenism of polycystic ovary syndrome (PCOS) in Chinese women, a case-control study was conducted in the Reproductive Medical Center of the Second Affiliated Hospital of Zhengzhou University (Zhengzhou, China). 96 PCOS patients and 78 healthy control women were included. CYP11alpha (tttta)n repeat-polymorphism genotyping analysis was performed by using polymerase chain reaction (PCR). Serum pituitary hormone and total testosterone levels were measured by ELISA. 4 different CYP11alpha (tttta)n allelles were identified, corresponding to 4-, 6-, 8-, and 9-repeat-unit alleles. The frequency and distribution of these alleles are 0.16, 0.33, 0.38, and 0.13 respectively in PCOS patients, as compared with 0.20, 0.34, 0.35, and 0.11 respectively in healthy controls. There were no significant differences between these two groups. Moreover, no correlation between the polymorphism of CYP11alpha gene and serum testosterone level of patients with PCOS and controls was observed. It is concluded that microsatellite polymorphism (tttta)n of gene CYP11alpha exists in Chinese women and the polymorphism of CYP11alpha gene does not play an important role in the pathogenesis of Chinese patients with PCOS, especially in patients with hyperandrogenism.
Cholesterol Side-Chain Cleavage Enzyme/*genetics ; Hyperandrogenism/complications ; Hyperandrogenism/*genetics ; Microsatellite Repeats ; Polycystic Ovary Syndrome/complications ; Polycystic Ovary Syndrome/*genetics ; *Polymorphism, Genetic/genetics

Polycystic ovary syndrome (PCOS) is a common disorder of premenopausal women, affecting 4 to 8% of this population. Diagnosis of PCOS lays on a combination of clinical, biological and ultrasound criteria that has been used variably worldwide. The phenotype of women with PCOS is variable depending on ethnic background and diagnostic criteria may rely on it. Fewer studies have extensively examined reproductive and metabolic characteristics and hyperandrogenism in Korean women. Despite the paucity of these studies, they are critical for the ascertainment of criteria for the diagnosis of PCOS. This review address the issues pertaining to diagnostic issues of PCOS in Korean women, specifically: reproductive and metabolic derangements and criteria for hyperandrogenism based on hirsutism and serum androgen concentrations. The prevalence (estimated) of PCOS in Korean women was 5.8%. To diagnose PCOS, the cut off value for hirsutism needs to be differently adjusted in Korean women. Regarding phenotypic characteristics of PCOS in Korean women, the various phenotypes of PCOS have the different overall morbidity (e.g. insulin resistance and hyperinsulinism, abnormal glucose metabolism and metabolic syndrome). Especially patients with oligomenorrhea/polycystic ovary and hyperandrogenism/polycystic ovary did not seem to have metabolic derangements. Thus these subgroups need to be determined if they can be classified as PCOS.
Female ; Glucose ; Hirsutism ; Humans ; Hyperandrogenism ; Hyperinsulinism ; Insulin Resistance ; Ovary ; Phenotype ; Polycystic Ovary Syndrome ; Prevalence

OBJECTIVES: To investigate the distribution and functional significance of CYP11alpha (tttta)n microsatellite polymorphism in Korean patients with polycystic ovary syndrome MATERIALS AND METHODS: Analysis of CYP11alpha(tttta)n microsatellite polymorphism was carried out on DNA samples from 97 patients with polycystic ovary syndrome and 70 normal controls. Comparison were done between PCOS patients and controls concerning CYP11alpha (tttta)n microsatellite polymorphism genotype or allele frequencies. RESULTS: The most frequent allele observed in the controls was an allele with six repeats (60.7%). Significant difference in the frequency of genotype (4R (-) genotype) having no copy of four-repeat-allele were observed between PCOS patients and controls (66.0% vs 34.0%, p=0.038, OR=1.939). But no significant difference was observed in the serum levels of total testosterone or free testosterone between 4R (+) genotype and 4R (-) genotype among PCOS patients. However, hyperandrogenic PCOS patients with 4R (+) genotype showed a higher serum testosterone levels compared to controls (mean+/-S.D: 0.49+/-0.21 ng/ml vs 0.37+/-0.18 ng/ml, p=0.037). CONCLUSION: The alleleic distribution of CYP11alpha (tttta)n microsatellite polymorphism in Korean subjects were different from those reported in Caucasians. CYP11alpha (tttta)n microsatellite polymorphism was associated with polycystic ovary syndrome in the Korean population, and may play a role in the synthesis of androgens in patients with polycystic ovary syndrome.
Alleles ; Androgens ; DNA ; Gene Frequency ; Genotype ; Hirsutism ; Humans ; Hyperandrogenism ; Microsatellite Repeats* ; Polycystic Ovary Syndrome* ; Testosterone

The SAHA syndrome is an acronym which stands for seborrhea, acne, hirsutism and androgenic alopecia. The SAHA syndrome generally occurs in young to middle-aged women and may be caused by elevated blood levels of androgens or increased androgen-driven peripheral response with normal circulating androgen levels. In SAHA syndrome, careful diagnostic and clinical evaluation is necessary in order to identify the cause of peripheral hyperandrogenism, and to exclude androgen-producing tumors. SAHA can be classified into 5 subtypes: familial, ovarian, adrenal, hyperprolactinemic SAHA and HAIRAN (hyperandrogenism, insulin resistance, acanthosis nigricans) syndrome. Among them, ovarian SAHA syndrome is associated with polycystic ovarian syndrome. We report a case of ovarian SAHA syndrome in 15-year-old girl who showed seborrea, acne, hirsutism and androgenic alopecia associated with polycystic ovarian syndrome.
Acne Vulgaris ; Adolescent ; Alopecia ; Androgens ; Dermatitis, Seborrheic ; Female ; Hirsutism ; Humans ; Hyperandrogenism ; Insulin Resistance ; Polycystic Ovary Syndrome