Introduction

Achard-Thiers Syndrome is a rare disorder mostly affecting women who have gone through menopause. Also known as ‘diabetic-bearded woman syndrome’, as the name suggests, it is a condition where the affected individual is usually a woman with excessive facial hair and diabetes. This condition is typically characterised by elevated levels of male hormones and type 2 diabetes^1,2

Because this syndrome is so rare and causes complex hormonal imbalances, proper management, and treatment are required to have the least possible effect on affected women's health and quality of life.¹ This article explores Achard-Thiers Syndrome by focusing on effectively managing and treating this complex condition.

Understanding Achard-Thiers Syndrome

Characteristics

The condition is characterised by a mix of features that indicate its influence on the body's hormonal and metabolic systems. It mainly includes the following traits:

• Type 2 diabetes (elevated blood sugar levels)
• Excessive androgen (male hormone) levels in females

Some features are linked to the overproduction of male hormones. This typically includes:

• Hirsutism or too much facial or body hair growth (mainly on the face, chest, and back)
• A deep, masculine voice
• Acne on face
• Enlarged clitoris
• Obesity
• Hyperplasia or adenoma of the adrenal gland
• Infertility³

In addition, a detailed patient history of affected women often reveals:

• Changes in menstruation, such as irregular or extremely light periods in a person who has previously experienced regular menstruation (oligomenorrhea)
• A sudden stoppage of menstruation (amenorrhoea) soon after the first menstruation (menarche).
• These menstrual issues are usually followed by excessive body hair growth and sudden weight gain.²

Causes

The exact cause of developing Achard-Thiers syndrome remains unclear. Major risk factors for Achard-Thiers syndrome include being an overweight or obese woman, particularly after menopause. 

• The primary cause of Achard-Thiers Syndrome is diabetes. This happens when the body doesn't produce enough insulin, leading to high blood sugar levels
• Stress can also contribute to diabetes by increasing the levels of hormones like cortisol, adrenaline, glucagon, and growth hormone. These hormones raise blood sugar levels, putting extra strain on the pancreas, which produces insulin
• During pregnancy, weight gain and higher levels of estrogen and placental hormones can block insulin, leading to higher blood sugar levels. This can increase the risk of developing diabetes and potentially Achard-Thiers Syndrome
• Some medications like thiazide diuretics (often used to treat high blood pressure), adrenal corticosteroids  (used to treat various conditions like asthma and arthritis), and hormonal contraceptives can also trigger the syndrome
• Family history plays a significant role in Achard-Thiers Syndrome. If you have a family member with this condition you are more likely to develop this condition. Additionally, if a woman has a blood relative with Polycystic Ovary Syndrome, there's a 50% chance she may also develop Achard-Thiers Syndrome. However, it is not yet clear how this condition is passed down in families^{1, 2, 4}

Treatment Strategies

Typically, the treatment plan is created around the patient's symptoms. Type 2 diabetes mellitus and indicators of excess testosterone are often the predominant symptoms, occurring throughout the postmenopausal period.¹

Hormonal Therapy

Since Achard-Thiers Syndrome often involves an imbalance of hormones, with higher levels of male hormones (androgens) in women, a crucial component of treating this syndrome is hormone replacement therapy. It helps balance the levels of male and female hormone levels in postmenopausal women.^1,4

Anti-androgens

The symptoms of androgen excess can also be treated with anti-androgens. These drugs assist in lowering or blocking the effects of male hormones in your body. It also helps to restore normal hormonal balance and reduce symptoms like excessive facial hair, acne, and voice deepening. The most common treatment for younger women with PCOS is to reduce excess androgen production by using an oral contraceptive.^1,5

Managing Type 2 Diabetes

Managing type 2 diabetes is crucial for individuals with Achard-Thiers Syndrome. Medicines are important in regulating sugar levels in blood.^3,4 Some of the recommended medications to control blood sugar and insulin levels in your  body include:

• Sulfonylureas: Help your pancreas make more insulin
• Meglitinides: Stimulate quick and short bursts of insulin from the pancreas
• Biguanides: Reduce glucose production in the liver and make your body more sensitive to insulin
• Alpha-Glucosidase Inhibitors: Slow down the breakdown of carbohydrates in the intestines, which helps prevent blood sugar spikes
• Thiazolidinediones: Improve insulin sensitivity, making the body more responsive to insulin
• SGLT2 Inhibitors: Help the kidneys remove sugar via urine
• DPP-4 Inhibitors and GLP-1 Receptor Agonists: Help regulate blood sugar levels by increasing insulin release and reducing sugar production in the liver^3,4

For treatment to be effective, it's critical to keep an eye on your blood sugar levels. Your doctor will tailor your treatment plan based on your blood sugar readings.

Lifestyle and Supportive Management

Diet and Nutrition

The management of diabetes greatly depends on dietary education and weight loss. While there isn't a specific diet designed to treat type 2 diabetes, these adjustments can help manage the condition better and promote a healthier way of life. 

• Make small, regular changes to your diet for better health
• Make healthy, low-fat, and low-calorie meal choices
• To improve digestion and control blood sugar levels, prioritise meals high in fibre
• For a healthy alternative, use natural sugars instead of artificial ones
• Include foods high in nutrients for overall health comprising fruits, vegetables, and certain starchy foods such as rice, pasta, and potatoes
• Consider meals that help manage blood sugar levels
• Include foods rich in vitamin E for added benefits
• If you use medications that might induce hypotension, try not to skip meals⁶

Regular exercise

Maintaining a healthy weight is crucial for the management of Achard-Thiers Syndrome. It helps regulate blood sugar, lessens the risk of developing complications from diabetes, and eases some of the symptoms caused by hormone imbalances. Engaging in physical activity aids in managing your weight. Try to get in at least 2.5 hours of physical activity per week.^4,6

You could engage in activities like fast walking, climbing stairs, or more strenuous housework or gardening. See your doctor for advice on a suitable workout regimen.^4,6

Treatments for hirsutism

The excess hair growth linked with Achard-Thiers Syndrome can be effectively managed using certain cosmetic treatments. If you have hirsutism, your doctor might recommend at-home treatments.

At-home treatments

These include:

• Shaving
• Waxing and plucking
• Using hair removal creams
• bleaching to get rid of or lighten hair⁷

Longer-lasting hair removal

Longer-lasting hair removal is another effective solution. It involves laser hair removal and electrolysis. Laser hair removal can be performed by targeting and destroying hair follicles with focused laser beams. Usually, it takes several sessions to get the best effects. Compared to temporary techniques like waxing, this treatment is comparatively painless and offers a more long-lasting solution. Electrolysis is another hair removal technique that uses electric current to halt hair growth.⁷

However, before attempting these therapies, make sure you research them. There are risks associated with both, and individual outcomes vary.

In some cases, medications and topical creams might also be prescribed to slow down the growth of facial hair.⁷

Psychological Support

It is difficult to manage the physical signs of Achard-Thiers Syndrome, such as hirsutism and voice deepening. Seeking advice and treatment options from a healthcare expert is essential for medical assistance. Additionally, encouraging a positive body image through counselling, body positivity and activities that enhance self-esteem can have a significant effect. These steps not only help manage the physical aspects of the condition but also play an important role in reducing your mental and emotional stress, fostering overall well-being and resilience.⁴

Long-term Management and Follow-Up

A proactive approach to long-term health is necessary for the proper management of Achard-Thiers syndrome. You can follow these crucial tactics for preserving well-being and improving outcomes:

• Ensure that your weight is at the right level
• Cautious about using medicines that might induce diabetes
• Throughout your pregnancy, keep an eye on your blood sugar levels and maintain a healthy weight
• Try to lower triglyceride and cholesterol levels
• Minimising or quitting smoking, controlling blood pressure, and diabetes can lead to fewer problems and a better prognosis³

Summary

• Achard-Thiers Syndrome is a rare disorder that mostly affects postmenopausal women. It is marked by high levels of male hormones and type 2 diabetes
• Hormonal treatment, which includes anti-androgens, can lower symptoms like voice deepening and excessive hair growth by balancing hormone levels
• Managing type 2 diabetes is crucial and can be achieved through a combination of medications, a healthy diet, and regular exercise
• Hirsutism can be managed through at-home treatments like shaving, waxing, or  longer-lasting solutions including laser hair removal and electrolysis
• Psychological support, like counselling, can help cope with physical changes and improve mental well-being