Retrospective investigation of desired hormonal parameters in women suiting with hirsutism

Purpose: Hirsutism is a disorder defined as "male pattern hair growth" in women. Hirsutism causes psychosocial problems in women, a decrease in the quality of life, and costs with cosmetics, drugs and epilation applications. There may be morbidity and mortality depending on the underlying causes of hirsutism. In this study, we planned to retrospectively analyse the clinical, laboratory and hormonal characteristics of patients who applied to our outpatient clinic with the complaint of hair growth and were admitted with the diagnosis code of "hirsutism" (L68.0) according to the International Classification of Diseases (ICD), through automation records. Material and Method: Our study is a descriptive study, and the data of 353 women with an mFG score of 8 and above who were followed up with the diagnosis of "hirsutism" in Tekirdağ Namık Kemal University Medical Faculty Hospital between January 2016 and December 2021 were retrospectively analysed. After excluding other causes of hirsutism according to the 2003 European Society of Human Reproduction and Embryology and American Society of Reproductive Medicine (ESHRE/ASRM) PCOS diagnostic criteria, women who met at least two of the three criteria were diagnosed with PCOS (39). Hormonal tests of TT, DHEAS, E2, FSH, LH, PRL, cortisol, androstenedione, ST, 17-OHP, progesterone, SHBG, fT4, TSH, IGF-1 were evaluated retrospectively. Results: Of 353 cases, 2 (0.6%) were diagnosed as "secondary hirsutism". Cushing's Disease was diagnosed in 1 (0.3%) of these cases, and Acromegaly was diagnosed in 1 (0.3%) case. After the removal of these 2 individuals, the clinical and laboratory examinations of the remaining 351 cases were evaluated. The mean age of the 351 patients evaluated was 27.90±7.26, and the mean Body Mass Index (BMI) values were 27.90±7.06. The mean mFG score was 13.02±4.93. TT examination was requested from each of 351 (100%) cases. DHEAS level was present in 330 (94.01%) cases. 17-OHP level was measured in 210 (60%) cases, androstenedione in 15 (4.27%) cases, and ST in 32 (9.12%) cases. TT mean values were 44.86±20.99 ng/dl. The mean DHEAS and 17-OHP were 329.82±143.86 mcg/dl and 1.36±0.94 ng/ml, respectively; androstenedione and ST mean values were determined as 2.76±1.51 mg/ml and 2.12±1.46 pg/ml. FSH, LH levels were examined in 274 (78.06%) cases, the mean FSH was 5.99±3.84 miu/ml, the mean LH was 9.00±7.25 miu/ml, and the mean LH/FSH was 1.66±1.33. Estradiol (E2) level was evaluated in 256 (72.93%) cases. The mean E2 level was determined as 58.63±55.69. Insulin-like growth factor (IGF-1) was tested in 7 hirsutic patients with clinical findings suspicious for acromegaly. None of these were found to be high. 1 mg dexamethasone suppression test was performed in 49 (18.8%) patients among 261 patients whose baseline cortisol was measured. Cushing's syndrome was not detected in any of the 351 patients. PCOS was diagnosed in 189 (53.85%) cases meeting at least 2 of the three criteria. 103 cases did not have polycystic ovary (PCO) appearance on pelvic USG. Idiopathic hirsutism (IH) was diagnosed in 103 (29.34%) cases with androgen levels in the normal range, regular menstrual cycles, and no PCO on pelvic USG. 59 cases had clinical and laboratory hyperandrogenemia, had regular menstrual cycles, had no PCO appearance on USG, or had no USG record, and were classified in the idiopathic hyperandrogenemia (IHA) diagnosis group. Conclusion: Acromegaly was not detected in three hundred and fifty-one cases. This shows that it would be appropriate to ask for IGF-1 in the differential diagnosis of "Acromegaly" only in suspected patients. In our study, there were 49 (18.8%) patients who underwent 1 mg DST among 261 (74.36%) patients whose baseline cortisol was measured. Our results show that basal cortisol is not a necessary test unless there is clinical suspicion of adrenal insufficiency or Cushing's syndrome. In our study, in line with the literature, the most common cause of hirsutism was PCOS. However, it has been seen that the pelvic USG examinations of our patients are not sufficient. If pelvic USG was performed immediately and the results could be obtained in a short time, we guessed that the diagnosis of PCOS would have been made with more reliable criteria and some of the patients with a diagnosis of UHA would have been more clearly classified as a diagnosis of PCOS or pure UHA. Keywords: PCOS, Idiopathic hyperandrogenemia, oligomenorrhea, retrospective