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What is Hirsutism?

It is defined as the occurrence of growth of coarse terminal hair in a male sexual pattern in women & children

 

Idiopathic Hirsutism- Patients with hirsutism with or without endocrinologic evidence of androgen excess but with normal menses, normal sized ovaries, normal adrenal function and no evidence of androgen –secreting tumors are labelled as idiopathic hirsutism.

 

Causes-Disorders without virilization are associated with mild to moderately elevated androgen levels.

 

Without Virilization

  •  Cerebral: Stress                                             
  •  Ovarian: Pregnancy
  •  Menopause
  •  Ovarian luteoma

Pituitary: 

  • Cushing’s syndrome                                        
  • Ectopic ACTH
  • Hypo/hyperthyroidism                                                                                                                     

Combined ovarian& adrenal: Puberty             

Idiopathic hirsutism: Cutaneous

                                                                         

Drugs: Systemic steroids.

        

With / Without Virilization

Pituitary: Hyperprolactinemia

Ovarian: Polycystic ovary syndrome

Acromegaly

Theca/granulose cell tumor

Adrenal: Delayed

(adult onset) adrenal

Hilar/lipoid cell tumor

hyperplasia

Arrhenoblastoma

Cushing’s syndrome

Gynandroblastoma

Adrenal adenoma

Kruckenburg tumor(metastasis)

Adrenal carcinoma

Gonadal dysgenesis( ectopic testicular

 

Tissue)                     

Drugs: Anabolic steroids                                          

Progestins

 

With Virilization

 

Adrenal: Congenital adrenal hyperplasia

hyperthecosis

Ovarian: Ovarian

 

 Childhood onset adrenal hyperplasia

Hilar cell hyperplasia

 Adrenal-nest tumor

Drugs: Testosterone

 

Synthetic androgen.

 

Clinical Signs

                                                     

 

Signs of Defeminization-

  • Amenorrhoea
  • Reduction in breast size
  • Loss of female body contour

Signs of Virilization-

  • Clitoromegaly
  • Deepening of voice
  • Masculinization
  • Male pattern baldness
  • Coarsening of skin                                                                           

Associations-

  • Acne vulgaris
  • Seborrhoea                         
  • Obesity
  • Acanthosis nigricans
  • Cushingoid fat distribution
  • Striae
  • Hypertension
  • Galactorrhoea

Investigations-                  

  • Serum free testosterone
  • LH/FSH Ratio
  • Prolactin
  • DHEAS
  • 17 Hydroxy progesterone
  • TSH
  • Serum Insulin
  • Pelvic USG

Treatment

 

Hormonal Correction-

PCOD- Patients desirious of conception respond to clomiphene citrate, which induces ovulation. Those not desiring conception can be given cyclic cyproterone acetate, an antiandrogen along with ethinyl estradiol.

 

Spironolactone, 100mg daily cyclically, preferably with estrogens is equally effective.

Hirsutism improves in 4-6mths, but very thick hair needs to be treated cosmetically. 

 

Idiopathic Hirsutism-

  • Flutamide 250-750mg/day for 6-9mths.
  • Finasteride 2.5-7.5mg/day for 6-9mths.  

Congenital Adrenal Hyperplasia-

  • Low dose corticosteroids
  • Dexamethasone-0.3mg/day at bedtime for 4-6mths.

Cosmetic Correction-

  • Temporary:
    • Depilatory creams
    • Plucking
    • Threading
    • Waxing
    • Bleaching
    • Shaving
  • Permanent
    • Electrolysis
    • Lasers
    • IPL




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