Endocrine Abstracts

Introduction & Objective: Hidradenitis suppurativa (HS) is an inflammatory skin condition which predominantly affects women of childbearing age. Various metabolic and endocrine comorbidities can be associated with HS. The aim of this study was to evaluate the association of HS with male and female infertility.

Materials and Methods: We conducted a retrospective study between January 2012 and December 2022 enrolling all cases of HS in our dermatology department. The diagnosis of polycystic ovary syndrome (PCOS) was made in accordance with the revised Rotterdam criteria from 2003.

Results: We identified a total of 77 cases, with an average age of 39 years and a male-to-female sex ratio equal to 4,1. Among 15 women, four (26,7%) experienced fertility issues. The average age was 27,5 years (20-45 years), and in three cases (75%), HS occurred at a pediatric age (below 18 years). The diagnosis of PCOS was confirmed in two patients (13,3%) presenting with moderate to severe obesity (average BMI=35 kg/m²). Clinical presentations included irregular menstrual cycles and late-onset acne, indicative of clinical hyperandrogenism. Besides, hirsutism with an elevated blood testosterone level (3,99 nmol/l) was observed in one other young patient. The fertility assessment conducted in a reproductive-aged patient revealed hyperprolactinemia associated with a pituitary adenoma. HS manifested in these patients with either axillo-mammary (LC1) or follicular (LC2) phenotype (50% each), and classified as Hurley I or II. A treatment plan involving metformin and a dietary supplement containing myo-inositol and folic acid was prescribed for a single patient diagnosed with PCOS and prediabetes (fasting blood glucose level of 1.21 g/l). Finally, five married men (8,1%) reported unexplored infertility and/or sexual impotence.

Conclusions: Based on previous data, patients with HS face an elevated risk of infertility, particularly among females and individuals aged 36 to 45. Both HS and PCOS affect similar demographics, may be complicated by obesity and metabolic syndrome, and respond to antiandrogen agents. Our data align with those of other previous studies, such as the one by Garg et al., where the prevalence of PCOS in patients with HS was 9%. According to the adjusted analysis, the risk of PCOS would be twice as high in women with HS, independent of the influence of obesity and diabetes. In addition, because HS involves the inframammary folds, groin, genitals, and buttocks, patients with HS may be at risk for sexual dysfunction, including abnormal sexual function, impairment, and distress.