Although HS has been reported in two men with acromegaly , which is very likely due to a direct effect not of androgens but of growth hormone on apocrine glands, HS was not found to be associated with endocrine disorders.
In women HS has not been reported in association with ovarian or adrenal tumours, Cush-ing' syndrome, PCOS or NCAH, all known causes of hyperandrogenism with increased or abnormal androgen production. In fact, a possible association of HS with functional hyperan-drogenism (ovarian or adrenal dysfunction) merits investigation with modern biological and ultrasound markers .
HS usually begins after puberty when the apocrine glands are fully developed. A few cases have been reported in children, as clinical manifestations of premature adrenarche or early puberty [11, 12, 15]. This represents in fact the strongest evidence for an influence of andro-gens on HS. However, HS is more common in women and usually affects premenopausal women, although it may appear after menopause . The rare incidence of HS in post-menopausal women does not stand in favour of a role for androgens, since hyperandrogenism after the menopause has yet to be demonstrated. On the other hand, improvement during and re lapse after pregnancy, as well as premenstrual and menstrual exacerbations are usually noted, suggesting that hormones, at least oestrogens, may influence the course of the disease. Oestrogens in fact are known to interfere with inflammatory processes, independently of a direct genomic action of the steroids. This could account for their influence on the natural course of inflammatory diseases, such as acne, but also HS. Other observations in HS in terms of premenstrual and/or menstrual exacerbations may be unrelated to the oestrogen or androgen dependency of the disease.
Although HS may be associated in some women with classic signs of skin androgeniza-tion such as acne and/or hirsutism, no real association of HS with hirsutism (the major symptom of hyperandrogenism) has ever been reported. In a series of 70 women with HS, acne was not more frequent than in controls . The incidence of patients with signs of androgeniza-tion did not differ significantly between the two groups. Only a shorter menstrual cycle and a longer duration of menses in patients with HS were noted. Although there was no evidence in favour of or against an association with PCOS or with NCAH, these data indicate that HS is not accompanied by the usual clinical signs of androgenization.
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