Introduction

Achard-Thiers syndrome (also known as diabetic bearded women syndrome) is a rare condition experienced mainly in postmenopausal women. It can be characterised by type 2 diabetes mellitus (T2D) and hyperandrogenism.¹ In patients with T2D, the pancreas cannot produce enough insulin, and they experience insulin resistance, which prevents it from lowering high blood glucose levels (hyperglycemia). In general, insulin is released to regulate blood glucose levels.² In addition, hyperandrogenism is caused by an excess of androgen production in the body. Androgens are usually responsible for puberty and reproduction.³ Therefore, understanding Archard-Thiers syndrome is essential as the symptoms that arise from it have been linked to several cardiac complications, which this article will explore in further detail. 

Cause of Achard-Thiers Syndrome

The exact causes and incidence of this syndrome within the population are unknown. However, it is thought that several factors may contribute to this syndrome’s development,  including:

• T2D 
• Hyperandrogenism 
• Menopause 
• Genetic predisposition as it has appeared to be transmitted within families^1,4

Identifying the specific cause of this condition is still being researched; this will be crucial to preventing its associated cardiovascular diseases. However, people with Achard-Thiers can benefit from early diagnosis and appropriate treatment options to manage life with it.

Signs and symptoms of Achard-Thiers Syndrome

Symptoms of T2D are the first clinical signs of Achard-Thiers syndrome in older women.

These include:

• Frequent urination (Polyuria)
• Increased thirst (Polydipsia)
• Increased hunger (Polyphagia)
• Weight loss¹

Overproduction of androgens also leads to other symptoms of the syndrome, including:

• Increase in body hair on the face, chest and back (Hirsutism)
• Receding scalp hairline or male pattern baldness
• Deeping of the voice
• Acne
• Increased muscle mass
• Enlarging of clitoris (Clitoris Hypertrophy)
• Irregular menstrual cycle
• Infertility
• Osteoporosis
• Arterial hypertension
• Obesity^1,4

Cardiovascular Complications

Achard-Thiers syndrome is associated with an increased risk of cardiovascular disease due to both its T2D and hyperandrogenism characteristics. According to studies, almost 50% of patients with T2D are at a greater risk for early death and disability, similar to those with hyperandrogenism as a result of cardiovascular disease.^5,6

Several cardiovascular complications can occur, including heart failure (HF), stroke, myocardial infarction (MI), and coronary artery disease (CAD). As women enter their postmenopausal years, hyperandrogenism, obesity and other risk factors contribute to the development of T2D. It is here where women are susceptible to developing the rare Achard-Thiers syndrome, which can lead to cardiovascular diseases. Evidence suggests that postmenopausal women with hyperandrogenism are associated with higher cardiovascular disease and cardiovascular mortality risks.^5,6

However the mechanisms aren’t completely understood yet, so further research is still required.⁶

To reduce mortality and incidence rates from cardiovascular complications, both T2D and hyperandrogenism need to be diagnosed and managed early. To avoid cardiovascular complications, blood glucose levels may be the most important to control, as stated by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), and blood pressure monitoring and lifestyle changes must be made.⁵

Diagnosis of Achard-Thiers Syndrome

A diagnosis is crucial to developing a treatment plan. This determines whether a patient may develop Achard-Thiers syndrome or has already developed it. You can be assessed for this condition in several different ways:

Clinical Assessments

 You can be clinically assessed by clinicians for symptoms of both T2D or hyperandrogenism.

Testing for  hyperandrogenism can include:

• Examining physical symptoms - Such as excessive hair growth, if the patient exhibits or mentions it
• Measurement of hormone levels through blood tests - Such as total testosterone, free testosterone, Androstenedione, Dehydroepiandrosterone sulphate (DHEAS) and 17-hydroxyprogesterone³

Testing for T2D can be done through blood tests to identify:

• Fasting plasma glucose - measuring blood glucose levels without eating or drinking anything other than water. 
• A1C levels - measuring the average blood glucose levels over a few months^1,2

Having Achard-Thiers syndrome can put you at greater risk of developing cardiovascular diseases. Diagnosis of these heart conditions requires a testing of the heart. The following methods can be used to image the heart:

• Echocardiogram - shows blood flow through the heart's chambers and valves⁷
• Carotid ultrasound - uses sound waves to measure blood flow through carotid arteries⁸
• Coronary angiography - observes blood flow through coronary arteries⁹

Excess androgen levels and uncontrolled blood glucose levels can also be typical signs of Polycystic ovary syndrome (PCOS) in young adults. Being aware of this can help you negate the symptoms of Achard-Thiers syndrome when menopausal years are reached. This can then help to reduce the risk of heart problems too.¹

Management of Achard-Thiers Syndrome

Treatment and management of T2D and hyperandrogenism are essential for preventing Achard-Thiers syndrome. Lifestyle changes can be implemented early by managing diet and physical activity for patients.¹ In cases where the signs and symptoms of T2D and hyperandrogenism don't improve, treatments can be administered to prevent further health issues. The treatment given depends on the severity of Achard Thiers and the age of the patient.^10,11

T2D treatments include:

• Sulphonylureas 
• Glinides
• GLP-1 Analogues 
• Metformin 
• SGLT2 Inhibitors
• Insulin (only used when the drugs are ineffective in lowering blood glucose levels) 
• Regular monitoring of blood glucose to see how well the treatments are going^2,10

Hyperandrogenism treatments involve:

• Hormonal contraceptives 
• Anti-androgens 
• Cosmetic measures for facial hair removal^1,11

However, if cardiovascular diseases develop, they can be treated by:

• Antihypertensives 
• Statins 
• Anticoagulants
• Regular cardiovascular check ups¹⁰

Summary 

Achard-Thiers syndrome is a condition combining type 2 diabetes and excessive androgen levels in postmenopausal women. A variety of signs and symptoms can arise from this condition. Cardiovascular complications are possible from this syndrome that can lead to disabilities and be life-threatening. So, it’s important when insulin resistance and hyperandrogenism combined appear in a patient; they are diagnosed early and treated to prevent the condition from worsening. It’s important to visit a doctor if you believe you are experiencing any of these effects or symptoms to be provided with the appropriate care.