Hirsutes, excessive hair, endocrine hypertrichosis.
4.2.3 Hirsutism
Synonyms
Definition
Excessive terminal hair in a male pattern in a woman.
Aetiology & Pathogenesis
Around 5-10% of women may show signs of hirsutism.
There are many different causes.
Endocrine hirsutism: polycystic ovary syndrome; androgen-producing ovarian tumours; congenital adrenal hyperplasia (adrenogenital syndrome); acanthosis nigricans in insulin resistance, adrenal tumours; ACTH-cell hyperplasia; pituitary adenomas (Cushing’s disease); hyperprolactinemia; acromegaly.
Other causes: postmenopausal hirsutism; idiopathic hirsutism; ethnic; medication-induced hirsutism (e.g. anabolic steroids), paraneoplastic.
Signs & Symptoms
Growth of terminal and vellus hairs in woman on upper lip, chin, temples, between breasts, around nipples, on shoulders, linea alba and interior aspects of thighs. Can vary from discrete excess hairs to obvious male pattern with involvement of different locations that are highly variable.
Localisation
Upper lip, chin, temples, breast, abdomen, pubic area, arms, legs, back, buttocks.
Classification
Modified Ferriman-Gallwey system with 19 locations, min 0 to 36 max points. A score of more than 8 indicates androgen excess hirsutism.
Laboratory & other workups
Hormone status (FSH/LH ratio, DHEAS, free testosterone, SHBG,17-hydroxyprogesterone, prolactin), transvaginal ultrasound evaluation of ovaries.
Dermatopathology
Usually not required.
Course
Persistent, if an underlying cause cannot be found or treated adequately.
Complications
Psychosocial problems, tendency towards folliculitis after shaving, diabetes and cancer in polycystic ovarian syndrome.
Diagnosis
Typical hair pattern, endocrine screening with more detailed evaluation if hyperandrogenism is present.
Differential diagnosis
Ethnic variability. Hypertrichosis. Virilisation. Genetic syndromes causing hypertrichosis (consider especially in children).
Prevention & Therapy
Treat causes of hyperandrogenism.
Mechanical removal of hairs includes shaving, waxing, epilation, electroepilation, laser or light-assisted hair removal. Chemical agents to slow/stop hair growth (e.g. eflornithine). Consider spironolactone, finasteride, cyproterone or oral contraceptives.
Psychosocial support.
Podcasts
Tests
- A 43-year-old woman, mother of two normal children, comes to you because of recent beard growth coupled with hair loss on her scalp vertex. What disorders must be excluded?
- True or false?
- What does this 8-year-old girl have?
- This 25-year-old nurse presents because of therapy-resistant acne. What studies do you recommend?
- 26-year-old patient has polycystic ovary disease with hirsutism. Which treatments are appropriate for her?
- Statement 1 If a late-onset adrenogenital syndrome is diagnosed, the treatment of choice is systemic corticosteroids
- 55-year-old patient in menopause has recently developed hirsutism. What diseases must you exclude?
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