P18 EXACERBATION OF ANDROGENETIC ALOPECIA IN TWO POSTMENOPAUSAL WOMEN ASSOCIATED WITH ADRENAL CORTICAL ADENOMAS
Liu YH, Chang YH, Yu YS, Chen W
Department of Dermatology, Chang Gung Memorial Hospital, Kaohsiung, Chang Gung University, Taiwan

Progression of androgenetic alopecia in women with age is not uncommon. Many women with androgenetic alopecia may experience exacerbation of hair loss during the perimenopausal period and after menopause. Hair loss due to other underlying pathological conditions might thus be masked and ignored by clinicians. Here we present two middle-aged women with abrupt speedy aggravation of androgenetic alopecia manifest with profound vertex thinning and marked temporal hair line recession. The first is a 48-year-old woman, who, in addition to hair loss also developed beard over the chin and mild acne mainly around the mouth. Her menstruation had suddenly stopped 4 years ago and commencing menopause was diagnosed by gynecologist. The serum total testosterone was escalated to 462ng/dL (normal 10-90). Abdominal computed tomography scan detected a 1.6 cm nodule in the right adrenal gland, which, after removal by laparoscopic adrenalectomy, showed histopathology of adrenal cortical adenoma. Her menstrual cycle resumed one month later and there were also regrowth of hair on scalp and disappearance of beard in the subsequent few months. The other 59-year-old woman also had elevated circulating testosterone at 594ng/dL. A left adrenal nodule measured at 2.0x1.6cm was also diagnosed, but the patient refused operational intervention. None of the patients was found to have ovarian tumors. In summary, hyperandrogenemia should be considered in perimenopausal or postmenopausal women with unexpectedly rapid progression of hair loss to rule out the occurrence of adrenal tumors.