Achard Thiers Syndrome

Characterized by an insulin-resistant type 2 diabetes mellitus occurring primarily in postmenopausal women. It is associated with measurable increase in plasmatic androgen level.

Diabetic Bearded Women Syndrome; Adenoma Associated Virilism of Older Women.

First described in 1921 by Emile C. Achard, a French internist, and Joseph Thiers, a French Neurologist. The initial report of this medical condition was published in Paris in the Bulletin of the National Academy of Medicine.

Occurs in postmenopausal females. The incidence remains unknown.

Autosomal dominant or acquired.

Overproduction of male hormones androgens and other adrenocorticosteroid hormones (e.g., 11-oxysteroid) by the adrenal glands.

Clinical presentation based on findings of hirsutism, virilization, hypertension, and abnormally high serum androgen levels in postmenopausal females.

Development of secondary male sexual traits, obesity, hypertension with subsequent end-organ cardiovascular disease.

A complete medical history and physical examination must be obtained, especially the cardiovascular system. An ECG and echocardiography is recommended to eliminate the presence of a hypertrophic cardiomyopathy and cardiac disease as a result of long standing hypertension. A consultation with the endocrinology department is recommended. In the presence of severe obesity, the cardiorespiratory system must be evaluated to eliminate the potential effect of this complication and the possibility of chronic gastrointestinal reflux disease (GERD). The use of sodium citrate as prophylaxis for residual stomach content may be required prior to induction of general anesthesia.

Obesity may predispose patient to pulmonary aspiration of gastric contents during induction of general anesthesia, suggesting that a rapid sequence induction technique, when appropriate, may be indicated. The functional residual capacity may be compromised and postoperative ventilatory support required. Chronic hypertension may result in labile blood pressure control during anesthesia. Vascular access may be difficult as a result of obesity and subcutaneous tissue alterations.

Caution with sympathomimetics recommended.