Comparison of disease severity and ultrasonographic abdominal subcutaneous fatty tissue thickness in hirsute women

Betül Taş; Gökhan Artar; Mehmet Öncü; Saadet Pilten; Murat Altuntaş

doi:10.7197/223.vi.404897

Research Article

Comparison of disease severity and ultrasonographic abdominal subcutaneous fatty tissue thickness in hirsute women

Year 2018, Volume: 40 Issue: 3, 246 - 256, 30.09.2018

Betül Taş , Gökhan Artar Mehmet Öncü Saadet Pilten Murat Altuntaş

https://doi.org/10.7197/223.vi.404897

Abstract

Introduction

Hirsutism is a
condition defining as acquired excess of hairs in the androgen-sensitive skin
regions of women. It may be idiopathic, or can be resulted from metabolic or
androgen-related disorders.

Aim

In order to
determine of possible correlation between hirsutism scores and central obesity,
comparisons of abdominal subcutaneous fatty tissue thickness, metabolic
syndrome criteria and also hirsutism-related hormones, according to hirsutism
stages were aimed.

Materials
and Methods

A prospective
study was conducted on 144 women between the ages of 18-50, from October 2014
to March 2016. Beside hirsutism scores (determined by modified Ferriman-Gallway
evaluation system) and subcutaneous
abdominal fatty tissue thickness, metabolic syndrome criteria and
hirsutism-related hormones were detected. Fatty tissue thicknes were determined
by ultrasonographic measurements from 4 points around the umbilicus. Data was
compared to hirsutism stages, and evaluated with Number Cruncher Statistical
System 2007, as considered p < 0.05 was significant.

Results

Only moderate
and severe hirsutism groups were detected, and mean age was 24.47 ±7.52 years.
The most accompanying finding was polycystic ovary syndrome. Higher means for
fatty tissue thickness (p=0.0001 for each four region), weight, body mass
index, waist circumferences, systolic and diastolic blood pressures (each
p=0.0001), insulin (p=0.038), Homeostatic Model Assesment for Insulin
Resistance (p=0.033), triglyceride (p=0.003), free androgen index (p=0.004) and
total testosterone (p=0.036), and lower
means for high density lipoprotein cholesterol (p=0.003) and sex hormone
binding globuline (p=0.008) were obtained in severe hirsutism group. Existence of 1, 2 and 3 metabolic syndrome criteria, and
diagnosis of metabolic syndrome were also more detected in higher-score group
(each p=0.0001).

Conclusion

Women with
higher hirsutism scores are more likely to develop thicker subcutaneous
abdominal fatty tissue and metabolic syndrome than those with moderate scores.
Subcutaneous abdominal fatty tissue thicknesss may a simple metabotrophic
indicator for preliminary assessment of severity of hirsutism in especially
overweight women.

Keywords

Androgens , hirsutism , metabolic syndrome , subcutaneous fatty tissue

References

Reference 1- Klein J, Permana PA, Owecki M, et al. What are subcutaneous adipocytes really good for? Exp Dermatol 2007;16:45-70. PMID: 17181636Reference 2- Chaldakov GN, Fiore M, Tonchev AB, et al. Homo obesus: a metabotrophin-deficient species. Pharmacology and nutrition insight. Curr Pharm Des 2007;13:2176-9. PMID: 17627549Reference 3- Ibáñez L, Diaz M, Sebastiani G, et al. Treatment of androgen excess in adolescent girls: ethinylestradiol cyproteroneacetate versus low-dose pioglitazone-flutamide-metformin. J Clin Endocrinol Metab 2011;96:3361-6. PMID: 21865363Reference 4- Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reprod 2004;19:41-7. PMID: 14688154 Reference 5- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies". WHO Expert Consultation. The Lancet 2004;363:157-63. PMID: 14726171Reference 6- Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894:i-xii, 1-253. PMID: 11234459Reference 7- Alderman MH. JNC 7: brief summary and critique. Clin Exp Hypertens 2004;26:753-61. PMID: 15702631Reference 8- Coskun A, Ercan O, Arikan DC,et al. Eur J Obstet Gynecol Reprod Biol 2011;154:167-71. PMID: 21041013Reference 9- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the androgen excess and polycystic ovary syndrome society. Hum Reprod Update 2012;18:146-70. PMID: 22064667Reference 10- Clearfield M, Pearce M, Nibbe Y, Crotty D, Wagner A. The "New Deadly Quartet" for cardiovascular disease in the 21st century: obesity, metabolic syndrome, inflammation and climate change: how does statin therapy fit into this equation? Curr Atheroscler Rep 2014;16:380. PMID: 24338517Reference 11- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA 2001;285:2486-97. PMID: 11368702Reference 12- Carter GD, Holland SM, Alaghband-Zadeh J,et al. Investigation of hirsutism: testosterone is not enough. Ann Clin Biochem 1983;20:262-3. PMID: 6685986Reference 13- Blume-Peytavi U, Blumeyer A, Tosti A,et al; European Consensus Group. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 2011;164:5-15. PMID: 20795997Refernce 14- Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28: 412-9. PMID: 3899825Reference 15- Singh Y, Garg MK, Tandon N, Marwaha RK. A Study of Insulin Resistance by HOMA-IR and its Cut-off Value to Identify Metabolic Syndrome in Urban Indian Adolescents. Clin Res Pediatr Endocrinol 2013;5:245-51. PMID: 24379034Reference 16- Bertoli S, Leone A, Vignati L, et al. Metabolic correlates of subcutaneous and visceral abdominal fat measured by ultrasonography: a comparison with waist circumference. Nutr J 2016;15:2. PMID: 26732788Reference 17- Naeini F, Najafian J, Jazebi N. Hirsutism and body mass index in a representative sample of Iranian people. ARYA Atheroscler 2012;8:43-54. PMID: 23056100Reference 18- Reingold SB, Rosenfield RL. The relationship of mild hirsutism or acne in women to androgens. ArchDermatol 1987;123:209-12. PMID: 2949707 Reference 19- Napolitano M, Megna M, Monfrecola G. Insulin Resistance and Skin Diseases.Scientific WorldJournal 2015;2015:479354. PMID: 25977937Reference 20- Broekmans FJ, Knauff EA, Valkenburg O, et al. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006;113:1210-7. PMID: 16972863Reference 21- Ibáñez L, Díaz M, Sebastiani G, et al. Oral contraception vs insulin sensitization for 18 months in nonobese adolescents with androgen excess: posttreatment differences in C-reactive protein, intima-media thickness, visceral adiposity, insulin sensitivity, and menstrual regularity. J Clin Endocrinol Metab 2013;98:E902-7. PMID: 23547047Reference 22- Douchi T, Ijuin H, Nakamura S, et al. Body fat distribution in women with polycystic ovary syndrome. Obstet Gynecol 1995;86:516-9. PMID: 7675372Reference 23- Bochra F, Mélika C, Myrvat K,et al. Role of visceral obesity in metabolic disorders associated with hyperandrogenia in hirsute women. Tunis Med. 2005;83:532-6. PMID: 16383198Reference 24- Vigouroux C. What have we learned form monogenic forms of severe insulin resistance associated with PCOS/HAIRAN? Ann Endocrinol (Paris) 2010;71:222-4. PMID: 20362964Reference 25- Salley KE, Wickham EP, Cheang KI, et al. Glucose intolerance in polycystic ovary syndrome—a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92:4546-56. PMID: 18056778Reference 26- Panidis D, Tziomalos K, Papadakis E, et al. The clinical significance and primary determinants of hirsutism in patients with polycystic ovary syndrome. Eur J Endocrinol 2013;168:871-7. PMID: 23557988Reference 27- Al Kindi MK, Al Essry FS, Al Essry FS, Mula-Abed WA. Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism. Oman Med J 2012;27:471-4.Reference 28- Shojaei MH, Shirani S, Eshraghian MR, Soleymanzadeh M. Sonographic prediction of body fat volume (subcutaneous and visceral fat) in cardiovascular patients. J Tehran Heart Cent 2010;5:83-6. PMID: 23074573Reference 29- Wehr E, Möller R, Horejsi R, et al. Subcutaneous adipose tissue topography and metabolic disturbances in polycystic ovary syndrome. Wien Klin Wochenschr 2009;121:262-9. PMID: 19562283

Year 2018, Volume: 40 Issue: 3, 246 - 256, 30.09.2018

Betül Taş , Gökhan Artar Mehmet Öncü Saadet Pilten Murat Altuntaş

https://doi.org/10.7197/223.vi.404897

Abstract

References

Reference 1- Klein J, Permana PA, Owecki M, et al. What are subcutaneous adipocytes really good for? Exp Dermatol 2007;16:45-70. PMID: 17181636Reference 2- Chaldakov GN, Fiore M, Tonchev AB, et al. Homo obesus: a metabotrophin-deficient species. Pharmacology and nutrition insight. Curr Pharm Des 2007;13:2176-9. PMID: 17627549Reference 3- Ibáñez L, Diaz M, Sebastiani G, et al. Treatment of androgen excess in adolescent girls: ethinylestradiol cyproteroneacetate versus low-dose pioglitazone-flutamide-metformin. J Clin Endocrinol Metab 2011;96:3361-6. PMID: 21865363Reference 4- Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reprod 2004;19:41-7. PMID: 14688154 Reference 5- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies". WHO Expert Consultation. The Lancet 2004;363:157-63. PMID: 14726171Reference 6- Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894:i-xii, 1-253. PMID: 11234459Reference 7- Alderman MH. JNC 7: brief summary and critique. Clin Exp Hypertens 2004;26:753-61. PMID: 15702631Reference 8- Coskun A, Ercan O, Arikan DC,et al. Eur J Obstet Gynecol Reprod Biol 2011;154:167-71. PMID: 21041013Reference 9- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the androgen excess and polycystic ovary syndrome society. Hum Reprod Update 2012;18:146-70. PMID: 22064667Reference 10- Clearfield M, Pearce M, Nibbe Y, Crotty D, Wagner A. The "New Deadly Quartet" for cardiovascular disease in the 21st century: obesity, metabolic syndrome, inflammation and climate change: how does statin therapy fit into this equation? Curr Atheroscler Rep 2014;16:380. PMID: 24338517Reference 11- Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA 2001;285:2486-97. PMID: 11368702Reference 12- Carter GD, Holland SM, Alaghband-Zadeh J,et al. Investigation of hirsutism: testosterone is not enough. Ann Clin Biochem 1983;20:262-3. PMID: 6685986Reference 13- Blume-Peytavi U, Blumeyer A, Tosti A,et al; European Consensus Group. S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents. Br J Dermatol 2011;164:5-15. PMID: 20795997Refernce 14- Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28: 412-9. PMID: 3899825Reference 15- Singh Y, Garg MK, Tandon N, Marwaha RK. A Study of Insulin Resistance by HOMA-IR and its Cut-off Value to Identify Metabolic Syndrome in Urban Indian Adolescents. Clin Res Pediatr Endocrinol 2013;5:245-51. PMID: 24379034Reference 16- Bertoli S, Leone A, Vignati L, et al. Metabolic correlates of subcutaneous and visceral abdominal fat measured by ultrasonography: a comparison with waist circumference. Nutr J 2016;15:2. PMID: 26732788Reference 17- Naeini F, Najafian J, Jazebi N. Hirsutism and body mass index in a representative sample of Iranian people. ARYA Atheroscler 2012;8:43-54. PMID: 23056100Reference 18- Reingold SB, Rosenfield RL. The relationship of mild hirsutism or acne in women to androgens. ArchDermatol 1987;123:209-12. PMID: 2949707 Reference 19- Napolitano M, Megna M, Monfrecola G. Insulin Resistance and Skin Diseases.Scientific WorldJournal 2015;2015:479354. PMID: 25977937Reference 20- Broekmans FJ, Knauff EA, Valkenburg O, et al. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006;113:1210-7. PMID: 16972863Reference 21- Ibáñez L, Díaz M, Sebastiani G, et al. Oral contraception vs insulin sensitization for 18 months in nonobese adolescents with androgen excess: posttreatment differences in C-reactive protein, intima-media thickness, visceral adiposity, insulin sensitivity, and menstrual regularity. J Clin Endocrinol Metab 2013;98:E902-7. PMID: 23547047Reference 22- Douchi T, Ijuin H, Nakamura S, et al. Body fat distribution in women with polycystic ovary syndrome. Obstet Gynecol 1995;86:516-9. PMID: 7675372Reference 23- Bochra F, Mélika C, Myrvat K,et al. Role of visceral obesity in metabolic disorders associated with hyperandrogenia in hirsute women. Tunis Med. 2005;83:532-6. PMID: 16383198Reference 24- Vigouroux C. What have we learned form monogenic forms of severe insulin resistance associated with PCOS/HAIRAN? Ann Endocrinol (Paris) 2010;71:222-4. PMID: 20362964Reference 25- Salley KE, Wickham EP, Cheang KI, et al. Glucose intolerance in polycystic ovary syndrome—a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92:4546-56. PMID: 18056778Reference 26- Panidis D, Tziomalos K, Papadakis E, et al. The clinical significance and primary determinants of hirsutism in patients with polycystic ovary syndrome. Eur J Endocrinol 2013;168:871-7. PMID: 23557988Reference 27- Al Kindi MK, Al Essry FS, Al Essry FS, Mula-Abed WA. Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism. Oman Med J 2012;27:471-4.Reference 28- Shojaei MH, Shirani S, Eshraghian MR, Soleymanzadeh M. Sonographic prediction of body fat volume (subcutaneous and visceral fat) in cardiovascular patients. J Tehran Heart Cent 2010;5:83-6. PMID: 23074573Reference 29- Wehr E, Möller R, Horejsi R, et al. Subcutaneous adipose tissue topography and metabolic disturbances in polycystic ovary syndrome. Wien Klin Wochenschr 2009;121:262-9. PMID: 19562283

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Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Medical Science Research Articles
Authors	Betül Taş 0000-0001-5378-1478 Gökhan Artar 0000-0003-3303-5632 Mehmet Öncü 0000-0001-9425-4658 Saadet Pilten 0000-0002-6637-5206 Murat Altuntaş 0000-0003-0282-2721
Publication Date	September 30, 2018
Acceptance Date	September 24, 2018
Published in Issue	Year 2018 Volume: 40 Issue: 3

Cite

AMA	Taş B, Artar G, Öncü M, Pilten S, Altuntaş M. Comparison of disease severity and ultrasonographic abdominal subcutaneous fatty tissue thickness in hirsute women. CMJ. September 2018;40(3):246-256. doi:10.7197/223.vi.404897