Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 caucasian premenopausal women with hirsutism as the referral diagnosis.
Fertil Steril 2004;
82:1570-9. [PMID:
15589862 DOI:
10.1016/j.fertnstert.2004.06.040]
[Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 06/16/2004] [Accepted: 06/16/2004] [Indexed: 01/26/2023]
Abstract
OBJECTIVE
To perform an audit on the examination of hirsute patients and to establish a rational routine examination program in an outpatient endocrine clinic.
DESIGN
Systematic, retrospective audit.
SETTING
Academic tertiary-care medical center.
PATIENT(S)
Three hundred forty women with hirsutism as the referral diagnosis.
INTERVENTION(S)
Hormone analyses and ACTH tests during cycle days 2-8, 2 hours of oral glucose tolerance test (OGTT), and vaginal ultrasound.
MAIN OUTCOME MEASURE(S)
End diagnosis, fasting, 30-, 60-, and 120-minute oral glucose-stimulated levels of insulin and capillary blood glucose.
RESULT(S)
Two hundred one patients were diagnosed as having idiopathic hirsutism (IH) and 134 as having polycystic ovary syndrome (PCOS). End diagnosis: prolactinoma: n = 1, Cushing's syndrome: n = 1, androgen-producing ovarian tumor: n = 1, late-onset 21-hydroxylase defects: n = 2. During OGTT, 4.9% (13 of 263) had previously undiagnosed diabetes; no significant difference in diabetes prevalence was found between idiopathic hirsutism and PCOS. For 50.8%, fasting insulin values were in the upper quartile for a reference population.
CONCLUSION(S)
Initial evaluation of hirsute patients with irregular menses should include serum (s)-17alpha-hydroxyprogesterone, s-prolactin, s-Testosterone (T), and s-sex hormone-binding globulin. Further evaluation is needed in patients with markedly elevated s-T or with clinical Cushing's syndrome. Hirsute patients have a high risk of diabetes, although this could be due to the high number of overweight patients among this population.
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