HAIR-AN Syndrome

Aka: HAIR-AN Syndrome

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II. Definition: Hair-AN Acronym

  1. Hyperandrogenism (HA)
  2. Insulin Resistance (IR)
  3. Acanthosis Nigricans (AN)

III. Pathophysiology

  1. Primary abnormality
    1. Insulin Resistance causes increased Insulin
  2. Secondary abnormality
    1. Excess androgen secretion from ovaries

IV. Associated Conditions

  1. Hashimoto's Thyroiditis
  2. Grave's Disease

V. Differential Diagnosis

  1. See Hyperandrogenism
  2. See Hirsutism
  3. See Acanthosis Nigricans
  4. Diabetes Mellitus
  5. Acromegaly

VI. Labs

  1. General lab testing
    1. Complete Blood Count (CBC)
    2. Thyroid Stimulating Hormone (TSH)
    3. Serum Prolactin
    4. Serum Electrolytes (Chem7)
  2. Labs associated with Insulin Resistance
    1. Fasting Serum Glucose
    2. Consider Glucose Tolerance Test
  3. Labs associated with Androgen Excess
    1. See Hyperandrogenism

VII. Management

  1. General Measures
    1. Weight loss
    2. See Hirsutism
  2. Gonadotropin suppression
    1. Oral Contraceptives (low Androgenic Activity)
      1. Desogestrel (Desogen)
      2. Norgestimate (Ortho-Cyclen)
    2. Anti-androgens
      1. Spironolactone (Aldactone) 50 to 100 mg po bid
      2. Flutamide (Eulexin)
        1. Risk of hepatotoxicity
      3. Finasteride (Proscar) 5 mg per day
  3. Insulin Resistance Modifier
    1. Glucophage (Metformin) 500 - 850 mg PO qd to bid

VIII. References

  1. Barbieri (1994) J Reprod Med 39:327-36 [PubMed]
  2. Elmer (2001) Am Fam Physician 63(12): 2385-90 [PubMed]

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