Hyperandrogenism,
insulin resistance, and
acanthosis nigricans (HAIR-AN) is a severe subphenotype of
polycystic ovary syndrome (PCOS). A 32-year-old woman with HAIR-AN and class 3
obesity presented to an endocrinology clinic after she failed sequential trials of treatment with
metformin,
estrogen-
progestin OCP,
spironolactone,
leuprolide, and a
levonorgestrel intrauterine device. She complained of
hirsutism and
acanthosis nigricans severely affecting her quality of life and had secondary
amenorrhea. Laboratory evaluation showed extremely elevated
testosterone and
insulin levels and elevated
glycated hemoglobin A1c (HbA1c). She underwent laparoscopic sleeve
gastrectomy. One year after the surgery, she lost 32% of her
body weight and reported normalization of menses, dramatic improvement in
hirsutism, and near-resolution of
acanthosis nigricans. Her
testosterone,
insulin, and HbA1c normalized. This case demonstrates the central role of
hyperinsulinemia in HAIR-AN and suggests that aggressive measures to normalize
insulin resistance and reduce excess weight can effectively treat the reproductive abnormalities in this syndrome. We suggest that
bariatric surgery can be an effective cure for
HAIR-AN syndrome and that PCOS, including HAIR-AN, should be considered a comorbidity of
obesity during evaluation of
bariatric surgery candidates.