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Diagnosis and Treatment > Signs and Symptoms > Anovulation

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S Livadas Endocrine Unit, Metropolitan Hospital, Athens, Greece

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I Androulakis Endocrine Unit, Metropolitan Hospital, Athens, Greece

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N Angelopoulos Endocrine Unit, Metropolitan Hospital, Athens, Greece

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A Lytras Endocrine Unit, Metropolitan Hospital, Athens, Greece

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F Papagiannopoulos Novo-Nordisk, Athens, Greece

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G Kassi Endocrine Unit, Alexandra Hospital, Athens, Greece

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Summary

HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance (IR) and Acanthosis Nigricans, constitutes a rare nosologic entity. It is characterized from clinical and biochemical hyperandrogenism accompanied with severe insulin resistance, chronic anovulation and metabolic abnormalities. Literally, HAIR-AN represents an extreme case of polycystic ovary syndrome (PCOS). In everyday practice, the management of HAIR-AN constitutes a therapeutic challenge with the available pharmaceutical agents. Specifically, the degree of IR cannot be significantly ameliorated with metformin administration, whereas oral contraceptives chronic administration is associated with worsening of metabolic profile. Liraglutide and exenatide, in combination with metformin, have been introduced in the management of significantly obese women with PCOS with satisfactory results. Based on this notion, we prescribed liraglutide in five women with HAIR-AN. In all participants a significant improvement regarding the degree of IR, fat depositions, androgen levels and the pattern of menstrual cycle was observed, with minimal weight loss. Furthermore, one woman became pregnant during liraglutide treatment giving birth to a healthy child. Accordingly, we conclude that liraglutide constitutes an effective alternative in the management of women with HAIR-AN.

Learning points:

  • HAIR-AN management is challenging and classic therapeutic regimens are ineffective.

  • Literally HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance and Acanthosis Nigricans, represents an extreme case of polycystic ovary syndrome.

  • In cases of HAIR-AN, liraglutide constitutes an effective and safe choice.

Taxonomy:
Clinical Overview, Gland/Organ, Ovaries, Topic, Gynaecological endocrinology, Hormone, Androgens, Androstenedione, Insulin, Condition/ Syndrome, Hyperandrogenism, Hyperinsulinaemia, Insulin resistance, PCOS, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, Greece, Diagnosis and Treatment, Signs and Symptoms, Acanthosis nigricans, Acne, Amenorrhoea, Anovulation, Hirsutism, Hyperandrogenism, Hyperinsulinaemia, Insulin resistance, Investigation, Androstenedione, Glucose tolerance (oral), HOMA, Insulin, Testosterone, Medication, GLP1 agonists, Liraglutide, Related Disciplines, Gynaecology, Publication Details, Case Report Type, Novel treatment
DOI:
https://doi.org/10.1530/EDM-19-0150
Volume/Issue:
Volume 2020: Issue 1
Open access