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!Hormonal causes:<ref name=":3" />
!Hormonal causes:<ref name=":3" />
!Description:
!Description:
!Clinical Cues:
!Clinical cues:
|-
|-
|[[Polycystic ovary syndrome|PCOS]]
|[[Polycystic ovary syndrome|PCOS]]
|PCOS is a condition characterized by excess androgens that can lead to hirsutism, irregular periods, and even infertility. The excess androgens can lead to disruptions in normal body hormones in the [[Hypothalamic–pituitary–gonadal axis|hypothalamic-pituitary-gonadal axis]] leading to these symptoms.<ref>{{Cite web |url=https://academic.oup.com/jes/article/3/8/1545/5518341?itm_medium=sidebar&itm_content=jes&itm_source=trendmd-widget&itm_campaign=trendmd-pilot |access-date=2022-09-15 |website=academic.oup.com}}</ref>
|PCOS is a condition characterized by excess androgens that can lead to hirsutism, irregular periods, and even infertility. The excess androgens can lead to disruptions in normal body hormones in the [[Hypothalamic–pituitary–gonadal axis|hypothalamic-pituitary-gonadal axis]] leading to these symptoms.<ref>{{Cite web |url=https://academic.oup.com/jes/article/3/8/1545/5518341?itm_medium=sidebar&itm_content=jes&itm_source=trendmd-widget&itm_campaign=trendmd-pilot |access-date=2022-09-15 |website=academic.oup.com}}</ref>
|Characterized by having 2 of 3 Rotterdam Criteria.
|Characterized by having two of three Rotterdam criteria:


* Oligomenorrhea (less than 8 menses in a year)
* Oligomenorrhea (fewer than eight menses in a year)
* Clinical or biochemical evidence of hyperandrogenism
* Clinical or biochemical evidence of hyperandrogenism
* Polycystic ovaries on ultrasound
* Polycystic ovaries on ultrasound.<ref>{{Cite journal |last=Legro |first=Richard S. |last2=Arslanian |first2=Silva A. |last3=Ehrmann |first3=David A. |last4=Hoeger |first4=Kathleen M. |last5=Murad |first5=M. Hassan |last6=Pasquali |first6=Renato |last7=Welt |first7=Corrine K. |date=December 2013 |title=Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline |url=https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-2350 |journal=The Journal of Clinical Endocrinology & Metabolism |language=en |volume=98 |issue=12 |pages=4565–4592 |doi=10.1210/jc.2013-2350 |issn=0021-972X |pmc=5399492 |pmid=24151290}}</ref>
<ref>{{Cite journal |last=Legro |first=Richard S. |last2=Arslanian |first2=Silva A. |last3=Ehrmann |first3=David A. |last4=Hoeger |first4=Kathleen M. |last5=Murad |first5=M. Hassan |last6=Pasquali |first6=Renato |last7=Welt |first7=Corrine K. |date=December 2013 |title=Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline |url=https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-2350 |journal=The Journal of Clinical Endocrinology & Metabolism |language=en |volume=98 |issue=12 |pages=4565–4592 |doi=10.1210/jc.2013-2350 |issn=0021-972X |pmc=5399492 |pmid=24151290}}</ref>
|-
|-
|[[Cushing's syndrome|Cushing Syndrome]]
|[[Cushing's syndrome|Cushing Syndrome]]

Revision as of 21:53, 21 September 2022

"Hirsute" redirects here. For the botanical term, see Indumentum.
Hirsutism
SpecialtyDermatology, endocrinology
TreatmentBirth control pills, antiandrogens, insulin sensitizers[1]
Hirsutism depicted in a patient with PCOS and non-classical adrenal hyperplasia

Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin hirsutus meaning "hairy".[2] It may refer to a "male" pattern of hair growth that may be a sign of a more serious medical condition,[3] especially if it develops well after puberty.[4] Cultural stigma against hirsutism can cause much psychological distress and social difficulty.[5] Discrimination based on facial hirsutism often leads to the avoidance of social situations and to symptoms of anxiety and depression.[6]

Hirsutism is usually the result of an underlying endocrine imbalance, which may be adrenal, ovarian, or central.[7] It can be caused by increased levels of androgen hormones. The amount and location of the hair is measured by a Ferriman-Gallwey score. It is different from hypertrichosis, which is excessive hair growth anywhere on the body.[3]

Treatments may include birth control pills that contain estrogen and progestin, antiandrogens, or insulin sensitizers.[1]

Hirsutism affects between 5–15% of women across all ethnic backgrounds.[8] Depending on the definition and the underlying data, approximately 40% of women have some degree of facial hair.[9]

Causes

See also: Hyperandrogenism § Causes

The causes of hirsutism can be divided into endocrine imbalances and non-endocrine etiologies. It is important to begin by first determining the distribution of body hair growth. If hair growth follows a male distribution, it could indicate the presence of increased androgens or hyperandrogenism. However, there are other hormones not related to androgens that can lead to hirsutism. A detailed history is taken by a provider in search of possible causes for hyperandrogenism or other non-endocrine-related causes. If the distribution of hair growth occurs throughout the body, this is referred to as hypertrichosis, not hirsutism.[10]

Endocrine causes:

  • Familial: Family history of hirsutism with normal androgen levels.[13]
  • Drug-induced: medications were used before the onset of hirsutism. The recommendation is to stop the medication and replace it with another.[14]
  • Pregnancy or post-menopause: moderate hirsutism due to prolactin secretion and hyperandrogenism due to decrease estrogen production, respectively.[17]
  • Idiopathic: When no other cause can be attributed to an individual's hirsutism, the cause is considered idiopathic by exclusion.[14] In these cases, mensuration cycles and androgen levels are normal.[18]
Hormonal causes:[13] Description: Clinical cues:
PCOS PCOS is a condition characterized by excess androgens that can lead to hirsutism, irregular periods, and even infertility. The excess androgens can lead to disruptions in normal body hormones in the hypothalamic-pituitary-gonadal axis leading to these symptoms.[19] Characterized by having two of three Rotterdam criteria:
  • Oligomenorrhea (fewer than eight menses in a year)
  • Clinical or biochemical evidence of hyperandrogenism
  • Polycystic ovaries on ultrasound

[20]

Cushing Syndrome Cushing syndrome occurs when there is an endogenous or exogenous elevated levels of cortisol. One cause of endogenous Cushing syndrome is a adrenocorticotrophic hormone-secreting pituitary adenoma that is responsible for high secretion of not just cortisol but also androgens from the pituitary gland.[21] Cushing syndrome has a apparent symptoms including: Hirsutism weight gain, extra fat build up around the face, abdominal striae, and irregular menstruation.[21]
Congenital Adrenal Hyperplasia CAH can be attributed to several enzymatic deficiencies but the most common is 21-beta-hydroxylase. In CAH, a missing enzyme responsible for normal cortisol synthesis creates a build-up of androgen precursors. This precursor gets shunt to the androgen synthesis pathway leading to increase levels of androgen. Classical CAH is discovered at birth due to increased androgens during development causing ambitious genitalia. Meanwhile, non-classical CAH is found in puberty presenting as anovulation.[18] Can present similar to PCOS in non-classical CAH. Increase levels of 17-hydroxyprogesterone.[13][18]
Androgen Secreting Tumors Tumors in the adrenal glands or in the ovaries leading to increase levels of androgens. [18] Rapid progression and virilization symptoms.[13]
Other less common hormonal causes: Acromegaly: Elevated levels of growth factor-1. [17]

Hyperthyroidism or hypothyroidism: Elevated or decreased levels of thyroid hormones.[17]

Hyperprolactinemia: Elevated levels of prolactin.[17]

Each of these have their own distinct presentation.[18]

Diagnosis

Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth.[22] A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern virilization.[14] One method of evaluating hirsutism is the Ferriman-Gallwey Score which gives a score based on the amount and location of hair growth.[23] The Ferriman-Gallwey Score has various cutoffs due to variable expressivity of hair growth based on ethnic background.[24][25]

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound, due to the high prevalence of polycystic ovary syndrome (PCOS), as well as 17α-hydroxyprogesterone (because of the possibility of finding nonclassic 21-hydroxylase deficiency[26]). People with hirsutism may present with an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level, however, additional imaging is required to discriminate between malignant and benign etiologies of adrenal hyperandrogenism.[27] Levels greater than 700 μg/dL are indicative of adrenal gland dysfunction, particularly congenital adrenal hyperplasia due to 21-hydroxylase deficiency. However, PCOS and idiopathic hirsutism make up 90% of cases.[14]

Treatment

Treatment of hirsutism is indicated when hair growth causes patient distress. The two main approaches to treatment are pharmacologic therapies targeting androgen production/action, and direct hair removal methods including electrolysis and photoepilaiton. These may be used independently or in combination.[28]

Pharmacologic therapies

Common medications consist of antiandrogens, insulin sensitizers, and oral contraceptive pills. All three types of therapy have demonstrated efficacy on their own, however insulin sensitizers are shown to be less effective than antiandrogens and oral contraceptive pills.[29] The therapies may be combined, as directed by a physician, in line with the patient's medical goals. Antiandrogens are drugs that block the effects of androgens like testosterone and dihydrotestosterone (DHT) in the body.[12] They are the most effective pharmacologic treatment for patient-important hirsutism, however they have teratogenic potential, and are therefore not recommended in people who are pregnant or desire pregnancy. Current data does not favor any one type of oral contraceptive over another.[29]

List of medications:

Other methods

See also

References

  1. ^ a b c Barrionuevo, P; Nabhan, M; Altayar, O; Wang, Z; Erwin, PJ; Asi, N; Martin, KA; Murad, MH (1 April 2018). "Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis". The Journal of Clinical Endocrinology and Metabolism. 103 (4): 1258–1264. doi:10.1210/jc.2017-02052. PMID 29522176.
  2. ^ "hirsute adjective - Definition, pictures, pronunciation and usage notes | Oxford Advanced Learner's Dictionary at OxfordLearnersDictionaries.com". www.oxfordlearnersdictionaries.com. Retrieved 2021-07-22.
  3. ^ a b "Merck Manuals online medical Library". Merck & Co. Retrieved 2011-03-04.
  4. ^ Sachdeva S (2010). "Hirsutism: Evaluation and Treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Barth JH, Catalan J, Cherry CA, Day A (September 1993). "Psychological morbidity in women referred for treatment of hirsutism". J Psychosom Res. 37 (6): 615–9. doi:10.1016/0022-3999(93)90056-L. PMID 8410747.
  6. ^ Jackson J, Caro JJ; Caro G, Garfield F; Huber F, Zhou W; Lin CS, Shander D & Schrode K (2007). "The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism". International Journal of Dermatology. 46 (9). the Eflornithine HCl Study Group: 976–981. doi:10.1111/j.1365-4632.2007.03270.x. PMID 17822506. S2CID 25986442.
  7. ^ Blume-Peytavi U, Hahn S. "Medical treatment of hirsutism. Dermatol Ther. 2008 Sep-Oct; 21(5): 329-39. Review". {{cite journal}}: Cite journal requires |journal= (help)
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  9. ^ Blume-Peytavi U, Gieler U, Hoffmann R, Shapiro J (2007). "Unwanted Facial Hair: Affects, Effects and Solutions". Dermatology (Basel). 215 (2): 139–146. doi:10.1159/000104266. PMID 17684377. S2CID 9589835.
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