Saadet PİLTEN, Gökhan ARTAR, Murat ALTUNTAŞ, Betül TAŞ, Mehmet ÖNCÜ

Hirsute kadınlarda hastalık şiddeti ile ultrasonik abdominal subkütanöz yağ dokusu kalınlığının karşılaştırılması

Giriş: Hirsutizm kadınların androjene duyarlı deri bölgelerinde terminal kıllanma artışı şeklinde tarif edilen bir durumdur. İdiopatik olabileceği gibi metabolik nedenler ya da androjen yüksekliği ile ilişkili durumlar nedeniyle de ortaya çıkabilir. Amaç: Bu çalışmada hirsutizm skorlarının sentral obezite ile olası korelasyonunun belirlenmesi için, abdominal subkütanöz yağ dokusu kalınlığının yanı sıra, metabolik sendrom kriterleri ve hirsutizmle ilişkili hormon değerlerinin hirsutizmin evrelerine göre karşılaştırılması amaçlanmıştır. Yöntem: Araştırma Kasım 2014 ve Mart 2016 tarihleri arasında 18-50 yaş aralığındaki 144 kadın hasta üzerinde prospektif olarak yürütüldü. Deneklerin hirsutizm skorları (modifiye Ferriman-Gallway değerlendirme sistemi ile belirlendi) ve subkütanöz abdominal yağ dokusu kalınlıklarının yanı sıra, metabolik sendrom kriterleri ve hirsutizmle ilişkili hormon değerleri de tetkik edildi. Yağ dokusu kalınlığı umblikus etrafındaki 4 farklı bölgeden ultrasonografi ile ölçüldü. Elde edilen veriler hirsutizm evrelerine göre karşılaştırıldı. Bulgular: Sadece orta dereceli ve şiddetlii hirsutizm grupları tespit edildi ve deneklerin ortalama yaşı 24.47 ±7.52 idi. En fazla eşlik eden bulgu polikistik over sendromu idi. Şiddetli hirsutism grubunda diğer gruba göre, subkutan yağ doku kalınlığı (4 farklı bölgenin her biri için p=0.0001), kilo, vücut kitle indeksi, bel çevresi, sistolik ve diastolik kan basınçları (her biri için p=0.0001, insülin (p=0.038), insülin direnci homeostatik model değerlendirme indeksi (p=0.033), trigliserit (p=0.003), serbest androjen indeksi (p=0.004) ve total testosteron (p=0.036) değerleri anlamlı ölçüde yüksek bulundu. Aynı grupta, yüksek dansiteli lipoprotein kolesterol (p=0.003) ve seks hormon bağlayıcı globulin değerleri ise (p=0.008) diğer gruba göre anlamlı ölçüde düşüktü. 1, 2 ve 3 metabolik sendrom kriteri ve metabolik sendrom tanısı şiddetli hirsutizm grubunda anlamlı ölçüde fazla saptandı. Sonuç: Şiddetli hirsutizm grubundaki kadınlarda, daha kalın bir subkutanöz yağ dokusuna sahip olma ve metabolik sendrom geliştirme olasılığı orta şiddetli gruptakilere göre daha yüksektir. Özellikle obez hastalarda, subkütan abdominal yağ doku kalınlığı, hirsutizm şiddetinin ön değerlendirmesinde basit bir metabotropik gösterge olabilir.

Comparison of disease severity and ultrasonographic abdominal subcutaneous fatty tissue thickness in hirsute women

Introduction: Hirsutism is a condition defining as acquired excess of hairs in the androgen-sensitive skin regions ofwomen. It may be idiopathic, or can be resulted from metabolic or androgen-related disorders.Objective: In order to determine of possible correlation between hirsutism scores and central obesity, comparisons ofabdominal subcutaneous fatty tissue thickness, metabolic syndrome criteria and also hirsutism-related hormones,according to hirsutism stages were aimed.Method: A prospective study was conducted on 144 women between the ages of 18-50, from October 2014 to March2016. Beside hirsutism scores (determined by modified Ferriman-Gallway evaluation system) and subcutaneousabdominal fatty tissue thickness, metabolic syndrome criteria and hirsutism-related hormones were detected. Fattytissue thicknes were determined by ultrasonographic measurements from 4 points around the umbilicus. Data wascompared to hirsutism stages, and evaluated with Number Cruncher Statistical System 2007, as considered p < 0.05 wassignificant.Results: Only moderate and severe hirsutism groups were detected, and mean age was 24.47 ±7.52 years. The mostaccompanying finding was polycystic ovary syndrome. Higher means for fatty tissue thickness (p=0.0001 for each fourregion), weight, body mass index, waist circumferences, systolic and diastolic blood pressures (each p=0.0001), insulin(p=0.038), Homeostatic Model Assesment for Insulin Resistance (p=0.033), triglyceride (p=0.003), free androgen index(p=0.004) and total testosterone (p=0.036), and lower means for high density lipoprotein cholesterol (p=0.003) and sexhormone binding globuline (p=0.008) were obtained in severe hirsutism group. Existence of 1, 2 and 3 metabolicsyndrome criteria, and diagnosis of metabolic syndrome were also more detected in higher-score group (eachp=0.0001).Conclusions: Women with higher hirsutism scores are more likely to develop thicker subcutaneous abdominal fattytissue and metabolic syndrome than those with moderate scores. Subcutaneous abdominal fatty tissue thicknesss may asimple metabotrophic indicator for preliminary assessment of severity of hirsutism in especially overweight women.

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