hirsutism


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Hirsutism

 

Definition

Excessive growth of facial or body hair in women is called hirsutism.

Description

Hirsutism is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by. However, an inherited tendency, over-production of male hormones (androgens), medication, or disease, can cause it to appear at any age.
Women who have hirsutism usually have irregular menstrual cycles. They sometimes have small breasts and deep voices, and their muscles and genitals may become larger than women without the condition.

Types of hirsutism

Idiopathic hirsutism is probably hereditary, because there is usually a family history of the disorder. Women with idiopathic hirsutism have normal menstrual cycles and no evidence of any of the conditions associated with secondary hirsutism.
Secondary hirsutism is most often associated with polycystic ovary syndrome (an inherited hormonal disorder characterized by menstrual irregularities, biochemical abnormalities, and obesity). This type of hirsutism may also be caused by:
  • malfunctions of the pituitary or adrenal glands
  • use of male hormones or minoxidil (Loniten), a drug used to widen blood vessels
  • adrenal or ovarian tumors.

Causes and symptoms

Hirsutism is rarely caused by a serious underlying disorder. Pregnancy occasionally stimulates its development. Hirsutism triggered by tumors is very unusual.
Hair follicles usually become enlarged, and the hairs themselves become larger and darker. A woman whose hirsutism is caused by an increase in male hormones has a pattern of hair growth similar to that of a man. A woman whose hirsutism is not hormone-related has long, fine hairs on her face, arms, chest, and back.

Diagnosis

Diagnosis is based on a family history of hirsutism, a personal history of menstrual irregularities, and masculine traits. Laboratory tests are not needed to assess the status of patients whose menstrual cycles are normal and who have mild, gradually progressing hirsutism.
A family physician or endocrinologist may order blood tests to measure hormone levels in women with long-standing menstrual problems or more severe hirsutism. Computed tomography scans (CT scans) are sometimes performed to evaluate diseases of the adrenal glands. Additional diagnostic procedures may be used to confirm or rule out underlying diseases or disorders.

Treatment

Primary hirsutism can be treated mechanically. Mechanical treatment involves bleaching or physically removing unwanted hair by:
  • cutting
  • electrolysis
  • shaving
  • tweezing
  • waxing
  • using hair-removing creams (depilatories)
Low-dose dexamethasone (a synthetic adrenocortical steroid), birth-control pills, or medications that suppress male hormones (for example, spironolactone) may be prescribed for patients whose condition stems from high androgen levels.
Treatment of secondary hirsutism is determined by the underlying cause of the condition.

Prognosis

Birth-control pills alone cause this condition to stabilize in one of every two patients and to improve in one of every 10.
When spironolactone (Aldactone) is prescribed to suppress hair growth, 70% of patients experience improvement within six months. When women also take birth-control pills, menstrual cycles become regular and hair growth is suppressed even more.

Resources

Organizations

American Society for Reproductive Medicine. 1209 Montgomery Highway, Birmingham, AL 35216-2809. (205) 978-5000. http://www.asrm.com.

Key terms

Idiopathic — A term for a disease with no known cause, from the Greek stems idio (peculiar or separate) and pathy (disease).

hirsutism

 [her´soo-tizm]
abnormal hairiness, especially in women.

hir·sut·ism

(hĭr'sū-tizm),
Presence of excessive bodily and facial hair, usually in a male pattern, especially in women; may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of androgen excess due to tumors, or of nonandrogenetic or other drugs.
Synonym(s): hirsuties, pilosis
[L. hirsutus, shaggy]

hirsutism

(hûr′so͞o-tĭz′əm, hîr′-, hər-so͞o′-)
n.
Heavy growth of hair, often in abnormal distribution.
Excess body hair, which is divided into
(1) Androgen-independent hirsutism—entire body is covered with vellous hair evenly distributed over androgen-dependent and independent regions
Aetiology Congenital disease (e.g., Cornelia de Lange and Seckel syndromes), drugs (e.g., androgen analogues, anticonvulsants, corticosteroids, cyclosporine, minoxidil, phenytoin and progesterone analogues), metabolic disorders (e.g., anorexia nervosa, porphyria cutanea tarda)
(2) Androgen-dependent hirsutism—increased terminal hair over ‘androgenic’ regions of the face and upper chest

hirsutism

Excess body hair, which is divided into
1. Androgen-independent hirsutism–entire body is covered with vellous hair evenly distributed over androgen-dependent and -independent regions Etiology Congenital disease–eg, Cornelia de Lange and Seckel syndromes, drugs–eg, androgen analogues, anticonvulsants, corticosteroids, cyclosporine, minoxidil, phenytoin and progesterone analogues, metabolic disorders–eg, anorexia nervosa, porphyria cutanea tarda.
2. Androgen-dependent hirsutism– ↑ terminal hair over 'androgenic' regions of the face and upper chest.

hir·sut·ism

(hir'sū-tizm)
Presence of excessive bodily and facial terminal hair, in a male pattern, especially in women; may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of androgen excess due to tumors or drugs (e.g., nonandrogenetic drugs).
[L. hirsutus, shaggy]

hirsutism

Excessive hairiness. Hirsutism in women is due to an excess of male sex hormone (androgen). Hirsutism results from interaction between the androgen level and the sensitivity of the hair follicles to androgen, both of which may vary. It also relates to the levels of sex hormone-binding globulin. Pubic hair is entirely dependent on the presence of androgen. Hirsutism may rarely occur from an ovarian or adrenal gland tumour. but is usually hereditary, ethnic or just unfortunate. Hypertrichosis-generalized excessive hair growth-can be caused by certain drugs such as STEROIDS, PHENYTOIN and STREPTOMYCIN.

hir·sut·ism

(hir'sū-tizm)
Presence of excessive bodily and facial hair, usually in a male pattern, especially in women; may be present in normal adults as an expression of an ethnic characteristic or may develop in children or adults as the result of androgen excess due to tumors.
[L. hirsutus, shaggy]
References in periodicals archive ?
Modified Ferriman-Gallwey (F-G) score was used to assess the hirsutism, patients with score [greater than or equal to]8 were considered to have hirsutism.
During the initial visit, patients underwent a detailed medical history and physical exam, including a modified Ferriman-Gallwey hirsutism score and hormonal evaluation.
Conclusion: The efficacy of spironolactone plus cOCPs combination therapy is better than metformin alone in the treatment of hirsutism among patients of PCOS.
[2] Murat Atmaca, Ismet Seven, Rifki Ucler et al., "An Interesting Cause of Hyperandrogenemic Hirsutism," Case Reports in Endocrinology, vol.
Hirsutism was evaluated and diagnosed if the modified FerrimanGallwey score was [greater than or equal to] 8.
According to Rosenfield (2016), PCOS should be included as a differential diagnosis in adolescents who present with hirsutism, acne that is non-responsive to treatment, irregular menses, or obesity.
So androgens in the circulation remain as free androgens resulting in hirsutism. [10] This is indicated by the results of analysis as per Figure 1, which shows 38% cases with hirsutism.
[15] Depression in PCOS may be related to change in physical appearance as obesity, acne, and hirsutism lead to negative perception of self and social withdrawal, which culminates into depression.
Abnormalities that might signal health problems include menstruation that hasn't started within 3 years of breast budding, menstruation that hasn't started by age 14 with signs of hirsutism, menstruation that hasn't started by age 14 with a history or exam suggestive of excessive exercise or an eating disorder, and menses that are heavy and linked to a history of excessive bruising or bleeding.
Women suffering from PCOS exemplify a variety of clinical symptoms such as: menstrual disorders (53-66%), problems conceiving (42-73%), hirsutism (65%), obesity (35-38%); whereas about 20% of women do not experience any characteristic symptoms [1,2,5].