INTRODUCTION:

Achard-Thiers syndrome, it is one of a rare hormonal disorder, is also referred as diabetic-bearded women syndrome. This condition predominantly affects postmenopausal women and was first documented in 1921 by French physicians Emile Charles Achard and Joseph Thiers, after whom the syndrome is named.¹

In 1921, the first observation of co-existing hirsutism and diabetes was reported, linking this syndrome to adrenal cortex hyperplasia, as found during autopsy.²

This condition is frequently associated with Polycystic Ovary Syndrome (PCOS). This condition is a prevalent endocrine disorder among women of reproductive age. PCOS is characterized by insulin resistance, which can lead to hyperinsulinemia and ultimately diabetes.

The elevated insulin levels can stimulate ovarian androgen production, leading to symptoms such as facial hair growth, acne, and irregular menstrual cycles.

Researchers are still investigating the root cause of Achard-Thiers syndrome, with research hinting at a potential genetic connection, as some cases seem to run in families. Additionally, women with a first-degree relative (such as a mother or sister) diagnosed with polycystic ovary syndrome (PCOS) may be more likely to develop Achard-Thiers syndrome.³

DEFINITION:

Diabetic Bearded Women Syndrome refers to the co-occurrence of hirsutism (excessive facial or body hair in a male pattern) and diabetes, particularly type 2 diabetes mellitus, often seen in women with underlying hormonal imbalances.

Figure 1. Diabetic bearded women.

CAUSES :

The exact cause of this syndrome is unknown. it appears to be a genetic disorder that can be transmitted within families. The syndrome is linked to insulin resistance and hyperinsulinemia, where the body's cells don't respond properly to insulin, leading to high blood sugar levels.

50% of sisters of women with PCOS exhibit some form of the syndrome, but the precise genetic transmission mechanism remains unclear^.4

Key factors contributing to Achard-Thiers syndrome:

· Genetic Predisposition: mutations in certain genes potentially playing a role.

· Insulin Resistance and Hyperinsulinemia

· Polycystic Ovary Syndrome (PCOS).⁵

· Hyperandrogenism: The overproduction of androgens leads to hirsutism, deep voice, and clitoral hypertrophy.

· Congenital Adrenal Hyperplasia (CAH): it is an inherited condition affects the adrenal glands' ability to produce cortisol and aldosterone, leading to an overproduction of androgens

· Certain medications, such as anabolic steroids, testosterone, cyclosporine, minoxidil, danazol, and phenytoin, can cause hirsutism as a side effects.⁶

Other potential contributing factors are

Risk factors for type 2 diabetes include obesity, which can lead to insulin resistance, and a sedentary lifestyle, characterized by a lack of physical activity .⁷

Pathophysiology:

Due to Insulin Resistance

C ells become resistant to insulin, disrupting normal function.

Hyperglycaemia

Increased insulin levels.

Hyperandrogenism:

High levels of androgens (male hormones).

Hirsutism (excessive hair growth in body)

Deepening voice, and clitoral hypertrophy .⁸

Signs and symptoms :

Figure: 2 Hirsutism Figure:3 Type 2 diabetic mellitus

Figure:4 Infertility Figure: 5 Obesity

Due to high blood glucose include

Type 2 Diabetes: Common symptoms of type 2 diabetes include excessive thirst, frequent urination, unexplained weight loss, and high blood sugar levels.

Overproduction of androgens include

· Hirsutism

· Deep Voice: Changes in voice pitch due to increased androgen levels.

· Enlargement of the clitoris.

· Infertility

· Obesity

· Hypertension

· Osteoporosis

· Infrequent or very light menstrual periods

· Oligomenorrhea.⁹

Diagnostic evaluation:

The diagnosis typically based on patient's symptoms.

1. Blood tests, primarily focusing on hyperglycaemia and hyperandrogenism. It includes oral glucose tolerance test¹⁰

2. Confirm Medical history and perform physical examination for signs of both diabetes and hirsutism ¹⁰

3. General Examination

4. Diabetes Symptoms: Look for classic diabetes symptoms like increased thirst, frequent urination, unexplained weight loss, and slow-healing wounds.¹¹

5. Depending on the clinical case blood tests may be necessary to assess hormone levels (androgen, cortisol) and other metabolic parameters^.12

6. Imaging tests (CT or MRI) for adrenal glands or ovaries

Two-hour oral glucose tolerance test:

Figure: 6 Oral glucose tolerance test

Management:

It includes:

Medical management like

· Metformin, Sulfonylureas, or insulin therapy necessary to regulate blood sugar levels.

· Metformin is often the initial medication for type 2 diabetes

· Oral contraceptives are commonly used for younger women with PCOS.

· Blood Sugar Monitoring: -Regular blood sugar monitoring is essential to track the effectiveness of treatment and make adjustments as needed.

· Hormone Replacement Therapy (HRT):- Postmenopausal women with Achard-Thiers syndrome may be prescribed hormone replacement therapy (HRT) to help alleviate symptoms such as excessive hair growth.

· Antiandrogens: Certain medications, such as spironolactone, can be used to block the effects of androgens, potentially reducing hair growth.¹³

Surgical management:

If tumours are found, it will be removed

Complication:

Diabetes-related complications include

· Hypertension

· Cardiovascular disease

· Obesity

· Diabetic retinopathy

· Infertility

· Receding hairline/male pattern baldness: Hair loss patterns similar to those seen in men.

· Clitoral hypertrophy

· Irregular or absent menstruation/amenorrhea¹⁴

CONCLUSION:

Achard-Thiers syndrome is a endocrine disorder that affects postmenopausal women. Women with this syndrome have Hyperandrogenism, menstrual irregularities, and adrenal or ovarian abnormalities. But it appears to have a genetic component, with a significant familial transmission risk. Early recognition of symptoms is important as it may indicate underlying adrenal or ovarian pathology. Management focus on controlling diabetes, reducing androgen symptoms and treating any underlying tumour if present. A multidisciplinary approach involving endocrinologist, dermatologist and gynaecologist ensure better outcome for affected patient.

REFERENCES:

1. Firkin BG, Whitworth JA. Dictionary of Medical Eponyms. Parthenon Publishing; 1987. ISBN 1-85070-333-7.

2. Pal L. Polycystic Ovary Syndrome: Current and Emerging Concepts. Springer Science and Business Media; 2013. p. 97. ISBN 9781461483946.

3. Firkin BG, Whitworth JA. Dictionary of Medical Eponyms. Parthenon Publishing; 1987. ISBN 1-85070-333-7.

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7. Wilson JD, Foster DW, Kronenberg HM, et al. Williams Textbook of Endocrinology. 9th ed. Philadelphia: WB Saunders; 1998.

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10. Shore RN, DeCherney AH, Stein KM, et al. The empty sella syndrome: virilization in a 59-year-old woman. JAMA. 1974; 227(1): 69-70.

11. American Diabetes Association. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019; 42(Suppl 1):S90-S102.

12. Raun-Falco O, Plewig G, Wolff HH, et al. Dermatology. Springer Science and Business Media; 2012. p. 1115. ISBN 9783642979316.

13. Achard Thiers Syndrome [Internet]. NORD (National Organization for Rare Disorders). [cited 2020 Jul 30]. Available from: [website URL]

14. Pirart J. Pr4diab~te et grossesse. Analyse de 350 observations de femmes diab4tiques. Ann Endocrinol (Paris). 1954; 15:58-72.

Received on 29.04.2025 Revised on 11.07.2025

Accepted on 18.08.2025 Published on 23.02.2026

Available online from February 25, 2026

Int. J. Nursing Education and Research. 2026;14(1):80-82.

DOI: 10.52711/2454-2660.2026.00016

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