Hair Loss in a Female Patient with Diabetes: What's the Cause?

What's Causing This Post-Menopausal Woman's Hair Loss?
What's Causing This Post-Menopausal Woman's Hair Loss?

Mrs. S was a 55-year-old female who had been on metformin for more than 10 years to manage her type 2 diabetes. When she came into the office for a routine follow-up visit, she complained her hair had been “falling out.” She stated the drain in her tub was “full of hair” after each shower and said every time she brushed her hair, the bristles were “full.”

Mrs. S reported that at first she thought her hair loss might be a symptom of menopause, since her last menstrual period was more than two years ago. She had been on a daily regimen of combination estrogen and progesterone and said that though she felt generally well, she has mild fatigue most days. She denied hot flashes or night sweats and said she sleeps through the night.

Mrs. S has had a modest weight gain since her last visit, and her current BMI was 28. Her blood pressure was normal and maintained on a low dose of an ACE inhibitor. She has been on statin therapy for hyperlipidemia for eight years and has tolerated the medication well.

She denied using any supplements or herbal compounds. She does not use tobacco and, to the best of her stated knowledge, had not been around any unusual chemical exposures or other environmental toxicities.

Examination


Mrs. S appeared well when she walked into the clinic. She was alert and oriented, smiled and gave quick responses to questions. Her vital signs were normal: BP of 126/84mmHg, pulse rate 87, respiratory rate 16 and unlabored, temperature 98.3° F and pulse oxygenation 99% on room air.

Heart sounds were regular sinus rhythm without a murmur. Lungs were clear to auscultation bilaterally. Pupils were equal, round and reactive to light. Cranial nerves were intact to gross examination. Gait was normal. Her skin was warm and dry without any rashes or other lesions. The foot examination was also normal with intact pulses and sensation to monofilament.

Laboratory data showed a hemoglobin A1c of 7.2%, normal serum creatinine, and normal complete blood count with red cell indices in normal range.

Mrs. S has brown, chin-length hair worn loose – she denied using dyes or curling agents. The hair shafts were dry, but there were no obvious broken or split ends. Her scalp was normal without lesions or flaking. The hair appeared thin, but there were no patches of frank alopecia.