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Obesity and hirsutism: how close?

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Introduction: The idiopathic hirsutism is defined by excess of the hair in women with normal ovarian function and normal androgens. In obese hirsute women some level of insulin resistance and impaired glucose tolerance are seen and they are potentially connected to the hirsute appearance.

Case presentation: A 31-year old female with irrelevant family and personal medical history has progressive obesity and she started to present progressive hirsute appearance during the last 3 years. On admission, a Body Mass Index (BMI) of 37.7 kg sqm is calculated. She associates severe hirsutism at the level of face, sternum, breasts, abdomen, legs with a score Ferriman Gallwey of more than 20. Despite the severe clinical phenotype and the suspicion of Cushing’s syndrome the ovarian and adrenal tests were normal so obesity was considered the cause of clinical hyperandrogenemia. A strict hypo- caloric diet of daily 1200 kcal in association with physical exercise was recommended. Orally metformin (500 mg three times per day) and ethinyl estradiolcyproterone acetate for 21 consecutive days followed by 7 days drug-free per month were started. Nutritional, endocrine, and drug-free gynecological follow-up is necessary.

Conclusion: Based on the presented case, a discrepancy might be found between the clinical aspects (like severe hirsutism and obesity) and the endocrine finding which exclude the Cushing’ s syndrome or do not meet the classical polycystic ovary syndrome List of abbreviations: PCOS = polycystic ovaries syndrome, BMI = Body Mass Index, DXM = dexametasone, mg = milligram, FSH = Follicle Stimulating Hormone, LH = luteinizing hormone, TSH = Thyroid Stimulating Hormone, ACTH = Adrenocorticotropic Hormone

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