OVARIAN HYPERTHECOSIS, DIABETES AND HIRSUTIES IN POSTMENOPAUSAL WOMEN

OBJECTIVE We describe four patients with ovarian hyperthecosis and the effects of gonadotrophin releasing hormone on clinical and metabolic variables. DESIGN Open out-patient study. PATIENTS Four women presente d with post-menopausal hirsuties. They had significant hair growth acr oss the chest, upper back and shoulders. Three had histologically prov en ovarian hyperthecosis and a fourth had large ovaries visualized on ultrasound. All four women had pronounced risk factors for vascular di sease; hypertension, hyperlipidaemia and glucose intolerance, and thre e had already developed symptomatic vascular disease. RESULTS Gonadotr ophin releasing hormone agonist therapy resulted in significant reduct ion in plasma androgens and cosmetic reduction in hair growth but had no effect on hyperlipidaemia. CONCLUSION The post-menopausal women des cribed in this report were clinically considered to have hyperandrogen ism due to the pathological pattern of marked body hair over the upper trunk, Treatment with GnRH was very effective at reducing the severit y of the hirsuties. The post-menopausal women with hyperthecosis in th is report had a high prevalence of cardiovascular disease. Since hyper androgenism and insulin are considered risk factors for cardiovascular disease in premenopausal women with polycystic ovaries, we discuss th e possible relationship between insulin and the post-menopausal ovary.