Acronym for HyperAndrogenism, Insulino-Resistance and Acanthosis Nigricans.

Cause : mutation in the  tyrosine kinase domain of the insulin receptor ? One of the most frequent causes of disorders of the menstrual cycle, signs of hyperandrogenism and resistance to insulin in adolescents (prevalence 5%) and young women. It is a subset of the polycystic ovarian syndrome.

• hyperandrogenism: acne, progressive hirsutism, sometimes incipient baldness and clitoridomegaly; this is due to the action of insulin-like growth factor-1 on the ovarian stroma
• polycystic ovarian disease
• irregularities of menstrual cycle with absence or disorders of ovulation 
• insulin resistance: obesity
• acanthosis nigricans: hyperpigmented skin of smooth or warty appearance at the level of the neck and axillae (sometimes other skinfolds); this is due to the action of insulin-like growth factor-1 on the keratinocytes.

Treatment: weight loss, metformin for diabetes type 2, psychological support.

Anesthetic implications: 

management of an obese patient with or without type 2 diabetes; frequent latent depression and feelings of worthlessness.

References : 

•    Pfeifer SLE, Wilson RM, Gawkroger DJ. 
  Clearance of acanthosis nigricans associated with the HAIR-AN syndrome after partial pancreatectomy: an 11-year follow up. 
  Postgrad Med J 1999; 75: 421-3.

Updated: April 2019