Introduction: The term female pattern hair loss (FPHL) is commonly used synonymously with female androgenetic alopecia. While the the role of androgens and androgen receptor genes is well-defined in male androgenetic alopecia (AGA-M), its role in in the pathogenesis of FPHL is stil uncertain. More diffuse involvement, resulting in an oval-shaped alopecia surrounded by a rim of normal hair density (Luduigs classification) might be a clinical challenge. The aim of case report is to present the menopausal patient with full blown signs of androgen excess such as acne, seborrhea, hirsutism (SAHA: seborrhea, acne, hirsutism, and alopecia), obesity and pronounced psychological consequences.
Case description: female, born in 1952y. Since 2000y. (menopausis in 2004y) she gained 35 kgs (85.1 kg), BH 158 cm and since 2010y. she started to notice increased hairiness (hirsutismus) and weakening and hair loss (FPHL), in 2016 Grade 3. At that time on adrenal CT it was detected adenoma on one gland. Cushing syndroma and Chon syndroma excluded, but among laboratory finding significant was LH 18 U/l, FSH 44.4 U/l, testosteron 13.8 nmol/l, insulin (fasting) 27.1 mU/l, post prandial 281.6 mU/l. Fasting triglycerides 0.95 mmol/l, HDL-cholesterol 1.8 mmol/l, total holesterol 5.56 mmol/l. In two years period (206-2018) she managed to reduce her body weight to 75 kg, insulinemia to 11.9 mU/l, testosteronemia to 5.8 nmol/l. Alopecia and hirsutisms had been without change, so we decided to introduce cyproteron acetate tbl. 2x50 mg. First drop in T was noticed 1 year later (2019y.), but even before that after a year on that therapy patient noticed changes in reduced alopecia and hirsutismus. After 2 ys od therapy in 2021y. we noticed futher drop in T between 1.44 and 3.04. Clinical improvement was manifested in alopecia removal of Grade 3 in to Grade 1. In these time DHT (Barts) has been 10.1-21.7 (reference -23) ng/dl.
Discussion: The aim of this case report is to emphasize the need of normalisation the testosteron level (refrence 2.6 nmol/l) for obtaining the effect of reducion of androgenization, meaning withdrawal of alopecia and hirsutism. If we consider hyperinsulinemia as a triger hormon change for the cascade of further androgenisation, its reduction seems not not to be enough for beneficial efects. More further, hyperinsulinism was assocociated only with hypertension but not with characteristic lipid consetalation that runs with insulin resistance, high triglycerodes and low HDL cholesterol.
21 May 2022 - 24 May 2022