Androgen excess in women affects terminal hair growth patterns. In states of androgen excess, the upper lip, chin, chest, upper arms, and thighs, for example, can become hirsute. In the same person, however, hair growth on the scalp resembles male-pattern balding (androgenic alopecia). What best describes the reason for the different effects of androgens on hair growth on the scalp compared to other areas? (AIIMS Nov 2012)
|A||Androgen levels in the scalp are lower than they are in other parts of the body.|
|B||Hirsutism causes stress, which leads to male-pattern balding.|
|C||In the scalp, androgen excess causes hair to spend less time in the growth phase.|
|D||Sun-exposed areas tend to be less androgen-sensitive.|
Hirsutism causes stress, which leads to male-pattern balding.
1). Hirsutism is a common outpatient complaint and may be caused by hyperandrogenism, endocrine disorders, pregnancy, drugs, or congenital abnormalities.
2). This patient has rapidly progressive virilization and concern should be present for a virilizing tumor.
3). A number of options exist to rule out a virilizing tumor including measurement of the testosterone level or dehydroepiandrosterone sulfate (DHEAS) level.
4). Further imaging will localize a mass, if present, in the adrenals or ovaries.
5). Empirical therapy with an oral contraceptive or with spironolactone would be in dicated if the laboratory and radiographic evaluation does not reveal a virilizing tumor.
6). Laser therapy will be effective at removing the hair, but the long-term effects are yet to be determined.
7). As shown in the figure, dexamethasone suppression is useful to distinguish adrenal versus ovarian causes of excess androgens and may be utilized after assessing testosterone and DHEAS.
Algorithm for the evaluation and differential diagnosis of hirsutism. ACTH, adrenocorticotropic hormone; CAH, congenital adrenal hyperplasia; DHEAS, sulfated form of dehydroepiandrosterone; PCOS, polycystic ovarian syndrome.