••• Chapter 58^ Hyperandrogenism^587
❍ Define the metabolic syndrome.
Diagnosis requires three of the following five criteria: (1) increased waist circumference: >88 cm, (2) increased BP:
≥ 130 /85, (3) increased triglycerides: ≥150, (4) decreased HDL: <50, and (5) increased fasting glucose ≥100 or
previously established diabetes mellitus.
❍ What is “HAIR-AN” syndrome?
Hyperandrogenism, insulin resistance, and acanthosis nigricans.
❍ What is acanthosis nigricans?
Gray-brown, velvety, occasionally verrucous discoloration of the skin (neck, groin, axillae) associated with
hyperinsulinemia. It is characterized histologically by papillomatosis and hyperkeratosis.
❍ What are the two types of hair and which are most affected by androgens?
Vellus (fine, soft, short, and unpigmented) and terminal (long, coarse, and pigmented). The vellus hair that covers
the body of infants is called lanugo.
Terminal hair is most affected by androgens.
❍ True or False: One’s total endowment of hair follicles is determined prior to birth.
True. Hair follicles develop at approximately 8 to 10 weeks of gestation and are completed by 22 weeks of gestation
❍ What is hypertrichosis?
Excess terminal or vellus hair in areas not androgen dependent
❍ What drugs may cause hypertrichosis as an adverse effect?
Phenytoin, penicillamine, diazoxide, minoxidil, or cyclosporine.
❍ What medical conditions may be associated with hypertrichosis?
Hypothyroidism, anorexia nervosa, malnutrition, porphyria, and dermatomyositis.
❍ Is there a place for gonadotropin-releasing hormone agonist therapy in the treatment of hirsutism?
Yes. Typically only in the HAIR-AN or hyperthecosis patient who has been resistant to conventional first-line
therapies. Regimen consists of low-dose add-back using HRT or OCPs to avoid hypoestrogenism.
❍ Hair loss after pregnancy is explained by?
The anagen phase of hair growth is prolonged by estrogens thus increasing the absolute number of hair follicles in
this phase. Once the high estrogen levels end, many hair follicles enter telogen simultaneously, and are shed as new
hairs begin to grow.
❍ What is the Ferriman-Gallway score?
A grading system (1–4) scoring amount of hair growth and the location. This then can be used to follow objectively
and quantitate hair growth. Scores <8, 8–15, >15 generally indicate mild, moderate, and severe hirsutism,
respectively. However, because most women have scores <8, scores of 3 or higher fall outside the norm.