Achard Thiers Syndrome: Causes, Symptoms, Complications, And Treatment

Achard-Thiers syndrome (also known as diabetic bearded woman syndrome) can be described as a rare disorder that has been seen in women primarily in the postmenopausal period with type 2 (insulin-resistant) diabetes mellitus and signs of androgen excess.

Scientists are still looking for the root cause of the disorder, although it has been stated that ATS has been seen in women with family histories possessing the same medical condition. In 50% of the women with blood relation ( like the mother or a sister) with PCOS also form the same form of the syndrome.

Diabetes is generally described as a medical condition that occurs when your sugar level in the bloodstream is too high. Blood sugar or glucose is one of the main sources of energy in your body. Organically, to maintain the glucose levels insulin, A hormone produced by the pancreas helps your food get into your cells for effective functioning.

Two types of diabetes are currently known, that is type 1 and type 2 diabetes. In the case of type 2 diabetes, your body becomes resistant to insulin increasing the level of the blood sugar level, making it difficult for the whole body to process. It generally happens due to lifestyle choices or mutated genetics.

Type 2 diabetes with insulin resistance, the body becomes resistant to natural or medicated insulin, pushing your body to produce more insulin which can also lead to hyperinsulinemia ( or excess of insulin in the body).

postmenopausal bleeding is a condition where women get traces of period blood after one year of menopause. The bleeding can be a sign of an underlying life-threatening disease like cancer.

Medical professionals believe that there are several reasons behind postmenopausal bleeding, some of them are:

• Polyps: It is a type of tumor that grows into tissue inside your uterus, cervical canal, or cervix. Most of the time it is not cancerous, but it may cause spotting, heavy bleeding, or bleeding after sex.
• Endometrial atrophy: It is a medical condition where the tissue that lines your uterus starts to thin due to the low level of hormones like estrogen and progesterone post-menopause. This may lead to postmenopausal bleeding.
• Endometrial hyperplasia: Or thinking of uterine lining, caused due to high level of estrogen and too little progesterone post menopause causing the thinking and in most of the cases heavy bleeding.
• Vaginal atrophy: Or thinning of vaginal tissue is caused due to low levels of estrogen levels resulting in thinning of vaginal walls. This may cause thinning, drying, and inflammation in the walls which often cause bleeding after sex in the postmenopausal stage.
• Cancer: One of the most common symptoms of cancer associated with female genitals is unusual bleeding, especially after one year of menopause.
• STD: Sexually transmitted diseases like chlamydia, herpes, and gonorrhea may cause abnormal spotting and bleeding post-sex, even after menopause.
• Medications: Like hormone therapy, tamoxifen, and blood thinners can cause bleeding in women as a side effect of the medication.

Androgens play an important role in the production of the hormonal cascade that triggers the initial signs of puberty in the human body. Particularly in women, it stimulates hair growth in areas of pubic and underarm areas, also regulates the overall functioning of various organs which includes the reproductive tract, bone, kidneys, liver, and muscle.

Excess production of androgen in a women’s reproductive age will eventually lead to an endocrine disorder. Even though the main production of androgens is done by adrenal glands and the ovaries, peripheral tissues like fat and skin also aid the process by converting weak androgens to more potent ones.

The symptoms seen in women with Achard Thiers Syndrome hyperinsulinemia may include:

• Frequent urination
• Excessive thirst and hunger
• Weight loss
• Cravings for sugar
• Difficulty concentrating
• Feeling anxious or panicky
• Lacking focus or motivation
• Fatigue

Symptoms of postmenopausal bleeding in Achard Thiers Syndrome include:

• Vaginal dryness
• Decreased libido
• Insomnia
• Stress incontinence
• Increased urinary tract infections
• Weight gain

Other symptoms are directly related to the overproduction of androgens, these may include:

• Increased body hair
• Receding hairline
• Deepening of the voice
• Enlargement of the clitoris
• Infertility
• Obesity

Further complications in ATS may include:

• Oligomenorrhea - Infrequent or very light menstrual periods after having normal menstruation
• Amenorrhea or menarche
• Acanthosis nigricans

The medical diagnosis of the condition starts with a general examination of post-menopause complications along with high sugar levels and visible excessive hair growth on the body, especially the excessive growth of facial hair.

Since most of the affected women are diagnosed with hyperinsulinemic, an oral glucose tolerance test of two hours is being conducted to examine abnormally elevated levels of glucose in the blood.

The method of treatment is generally designed around the symptoms the patient shows. The main symptoms are usually postmenopausal period with type 2 (insulin-resistant) diabetes mellitus and signs of excess androgen.

Management of type 2 (insulin-resistant) diabetes mellitus:

• Healthy eating: Even though there is no specific diet designed to cure type 2 diabetes, doctors believe that some minor deity alterations like wholesome low fat and calorie, fibrous food in small and frequent portions along with replacement of artificial sugar with natural sugar will keep your diet on track for a healthy life.
• Regular exercise: A minimum of 30 minutes of moderate to extensive exercise is recommended to every individual for a healthy life, especially to diabetes patients to regulate the production of excess sugar levels. Consult your physician for an appropriate exercise plan.
• Weight loss: Obesity or weight more than your body mass index may trigger an increase in cholesterol and sugar level. Weight management will help you achieve normal sugar levels.
• Possibly, diabetes medication or insulin therapy: Types of medications like Metformin, Sulfonylureas, Glinides, Thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors may be prescribed by your doctor to regulate the insulin and blood sugar level of the body.
• Blood sugar monitoring: It is important to monitor your blood sugar level for effective treatment. Your medical advisor will design your whole regime based on your blood sugar level only.

Treatment for postmenopausal bleeding mainly revolves around the hormonal imbalance the patient faced during menopause and post-menopause bleeding, some of the methods may include:

• Estrogen and progestin therapy: This method of treatment involves the intake of artificial hormones like estrogen and progestin to treat vaginal and endometrial atrophy. It can be possible through various ways like oral or viginal pills, viginal creams, and rings that are inserted by your gynecologist only.
• Hysteroscopy: The procedure involves the removal of thickened parts of the uterine lining by inserting a hysteroscope into your vagina to make room for surgical equipment for the procedure.
• D&C (dilation and curettage): Identical to hysteroscopy, D, and C also involves removal of thickened areas of the uterine lining, this time the doctors use a process known as dilation to widen up the viginal walls for the procedure.
• Hysterectomy: Is a surgical process that involves the removal of some or all parts of your uterus. It is usually recommended in extreme cases like cancer.
• Medications: As per your medical examination, your doctor will prescribe medications like antibiotics, hormone regulators, and other medications to treat any possible infection or underlying illness.

Cosmetic measures have been used to remove the uncomfortable hair growth, some of the methods that are ideal and recommended by doctors are:

1. Shaving: One of the most convenient ways to remove excess hair growth from any and every part of your body. This method is safe for women to use every day to remove the body and facial hair with no specific side effects, yet the results do not end up for more than three days.

   For best effects, it's better to gently cleanse and exfoliate your skin before shaving to avoid any ingrown hairs. Apply a layer of soap or shaving cream to smoothen the surface to reduce any chances of cuts. The best way is to glide the shaver or the blade in the direction of hair growth.

2. Topical prescriptions: There isn’t a prescription topical cream to remove hair, but medications like Vaniqa are widely been recommended by medical professionals. The medication needs routine application ( twice a day in the gap of eight hours) to work, until it works you have to use other hair removal products to keep the hair removed. The medication needs a constant application to work and if the patient discontinues the application the hair might grow back.
3. Depilatory creams: Commonly known as hair removal creams, depilatory creams are another good alternative to remove facial hair. A combination of chemical compounds like sodium, titanium dioxide, and barium sulfide has been used to break down the hair protein which makes it easy to remove afterward with some water. Since the methodology of the depilatory creams is to remove hair from the roots, the results of hair removal creams can be longer than shaving.

   Even though they are easy to use and safe for most users, some might get skin reactions that may include symptoms like redness, bumps, and itchiness.

   If you are using it for the first time, it is recommended to have a patch test before applying it to the whole area.

   Use the cream as directed and wait for the next 24 hrs to see any signs of reactions. The product is available in the form of gel, foam, cream, and lotion. Furthermore, most of the depilatory products are flexible to use on every body part, but some of them are specifically designed for sensitive skin areas like the face and pubic.

4. Waxing: While waxing may seem painful and complicated, it is one of the most effective and natural ways to remove body hair from roots. One can go to the salon for hair removal, but it is hard when you have Achard Thiers Syndrome. So to save time and energy, one can select home wax remedies and strip kits.

   There are plenty of ways one can remove hair from wax, the first one is the traditional way where you melt the way at a certain temperature, apply a small portion of it on the concerned area, cover it up with a wax strip and just pull. For most of the body parts hard wax is recommended, but for facial hair soft wax is a good option.

   Important things to keep in mind while waxing at home is to use a wax warmer to have better control over the temperature. Like any other hair removal technique, it is important to conduct a patch test before full application. The procedure for safe and easy waxing is:

   • Clean your hands and exfoliate the area of the skin that you want to use wax on.
   • Firmly apply a small portion of the wax on the affected area and let it cool on your skin.
   • If required apply the strips and gently tap them on the wax to make it stick.
   • Firmly remove the strip in the direction of the hair growth in one quick motion.
   • Remove the leftover wax residue with the help of baby oil or a moisturizer.

   Another form of waxing is using cold wax strips, they are less complicated to use and easily accessible than the traditional wax. Rub the wax strips in between your palms to warm the wax and peel the strips to uncover the wax part, apply it on your skin and firmly press it for 30-45 seconds. Pull the wax strip in the direction of your hair growth and clean the residue with the post-wax wipes available in the package.

Summary: Achard-Thiers syndrome also known as diabetic bearded woman syndrome is a rare genetic disorder that has been seen in women who are suffering from postmenopausal period along with type 2 diabetes mellitus and the signs of androgen excess.