Wednesday, September 14, 2011

Women's health: Obesity and Hirsutism

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. How do calculate your BMI index
BMI= weight (kg)/ height (m2)

C. Hirsutism is defined as a condition of excessive hair growth in the places where are considered minimal or not at all.

D. How obesity associates with Hirsutism
1. In a study of Endocrinology of hirsutism" by Kopera D, Wehr E, Obermayer-Pietsch B., conducted by Department of Dermatology, Internal Medicine, Medical University, posted in PubMed, researchers indicated that Obesity associated reproductive and metabolic dysfunctions may aggravate the symptoms of PCOS. PCOS might be underdiagnosed in non obese women because lean PCOS phenotypes might be underestimated for the syndrome. Effective medical treatment of PCOS and associated hirsutism depends on the endocrinological expertise and experience of the therapist in each individual case. An algorithm for the treatment has not been established yet.

2. According to the study of "Endocrinology of hirsutism" by Kopera D, Wehr E, Obermayer-Pietsch B., posted in PubMed, researcher wrote that Hirsutism represents a primary clinical indicator of androgen excess. The most common endocrine condition causing hirsutism is polycystic ovary syndrome (PCOS). Diagnosing PCOS is not easy as the signs and symptoms are heterogenous. The newest diagnostic guideline made by the Androgen Excess and PCOS Society in 2006, claims the presence of hyperandrogenism, and ovarian dysfunction. Obesity associated reproductive and metabolic dysfunctions may aggravate the symptoms of PCOS. PCOS might be underdiagnosed in non obese women because lean PCOS phenotypes might be underestimated for the syndrome.

3. In the study of "Comparison of clinical and laboratory characteristics of cases with polycystic ovarian syndrome based on Rotterdam's criteria and women whose only clinical signs are oligo/anovulation or hirsutism" by Hassa H, Tanir HM, Yildiz Z., posted in PubMed, researchers concluded that non-PCOS women with only sign or symptom of oligo/anovulation or hirsutism had a more favorable endocrine milieu. These cases should be followed in vigilance in an aim to confront the development of short- and long-term adverse effects of impending PCOS in the future. Furthermore, different phenotypes of PCOS cases were clinically or biochemically similar in characteristics.

4. According to the study of "Management of polycystic ovary syndrome in childhood and adolescence" by Ojaniemi M, Tapanainen P, Morin-Papunen L.,posted in PubMed, researchers indicated in the clinical feature that typical features in adolescence include irregular menstrual cycles, acne, hirsutism, obesity and signs of insulin resistance such as acanthosis nigricans. Biochemical hyperandrogenism and polycystic ovaries are often present. However, some adolescents have no evidence of clinical and biochemical hyperandrogenism despite dysfunctional polycystic ovaries.

5. In a study of "Polycystic ovary syndrome: challenges in adolescence" by Oliveira A, Sampaio B, Teixeira A, Castro-Correia C, Fontoura M, Luís Medina J., posted PubMed, researchers filed in abstract that polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases in women of reproductive age. PCOS typically develops during adolescence and is a heterogeneous syndrome classically characterized by features of anovulation combined with signs of androgen excess (hirsutism, acne). Increasing obesity in adolescents probably exacerbates signs of PCOS, contributing to its earlier recognition.

6. Etc.

E. Treatments of Obesity and Hirsutism
1. According to the study of Six studies were included with n=164 participants. Three studies compared physical activity to minimal dietary and behavioural advice or no advice. Three studies compared combined dietary, exercise and behavioural interventions to minimal intervention, conducted by School of Public Health and Preventive Medicine, Monash University, posted in PubMed, researchers concluded that Lifestyle intervention improves body composition, hyperandrogenism (high male hormones and clinical effects) and insulin resistance in women with PCOS. There was no evidence of effect for lifestyle intervention on improving glucose tolerance or lipid profiles and no literature assessing clinical reproductive outcomes, quality of life and treatment satisfaction.

2. In the study of 151 girls with various complete and incomplete forms of precocious puberty, 20 girls with congenital adrenal hyperplasia, 20 with hirsutism, 18 with obesity, and 133 age-matched normal girls, conducted by University of Bologna, Italy, posted in PubMed, researchers sttated that Ultrasound imaging allowed an easy distinction between true precocious puberty and premature thelarche or idiopathic premature adrenarche. It was also helpful in the diagnosis of transient sexual precocity, although in these cases the differential diagnosis of precocious puberty can be difficult. In postmenarcheal patients with congenital adrenal hyperplasia, ultrasound study showed a low uterine volume and, frequently, a macrocyst in the ovary. In hirsute girls and in a few obese patients, ovaries had an increased volume and a microcystic structure, similar to those in polycystic ovary syndrome. Pelvic ultrasonography can be useful not only in diagnosing disorders in sexual development but also for greater understanding of the pathogenesis of these and other disorders.

3. Etc.
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