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'''For patient information, click [[Hirsutism (patient information)|here]]'''

{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = |Nuremberg chronicles - Strange People - Hairy Lady (XIIv).jpg
  Caption        = |A lady with hirsutism, as depicted in the ''Nuremberg Chronicle'' (1493)
         = |
}}
{{SI}}
{{CMG}}

==Overview==
'''Hirsutism''' (from Latin ''hirsutus'' = shaggy, hairy) is defined as excessive and increased [[hair]] growth in women in locations where the occurrence of [[terminal hair]] normally is minimal or absent. It refers to a male pattern of body hair ([[androgenic hair]]) and it is therefore primarily of cosmetic and [[psychological]] concern. Hirsutism is a [[symptom]] rather than a [[disease]] and may be a sign of a more serious medical indication, especially if it develops well after [[puberty]]. 

== Appearance and evaluation ==
Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their [[puberty]] ([[chest hair|chest]], [[abdominal hair|abdomen]], back and [[facial hair|face]]). The medical term for excessive hair growth that affect both men and women is [[hypertrichosis]].

One method of evaluating hirsutism is the [[Ferriman-Gallwey score]] which gives a score based on the amount and location of hair growth on a woman.
 
==Etiology==
The cause of hirsutism can be either an increased level of [[androgen]]s (male [[hormone]]s) or an oversensitivity of [[hair follicles]] to androgens. Male hormones such as [[testosterone]] stimulate hair growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a high level of male hormones include [[Acne vulgaris|acne]] and deepening of the voice and increased muscle mass. 

Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.

It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.

The following may be some of the conditions that may increase a woman's normally low level of male hormones:
* [[Polycystic ovary syndrome]] 
* [[Cushing's disease]] 
* [[Tumor]]s in the [[ovaries]] or [[adrenal gland]] ([[cancer]])
* [[Congenital adrenal hyperplasia]]
* [[Insulin resistance]]
* Drugs like [[Ciclosporin]], [[conjugated estrogens]], [[Desogestrel and Ethinyl Estradiol]], [[Dexamethasone]], [[ethynodiol diacetate and ethinyl estradiol]], [[Ethosuximide]], [[Fluoxymesterone]], [[Methyltestosterone]], [[Oxandrolone]], [[Oxymetholone]], [[prednisolone]], [[Tiagabine]]

== Physical Examination ==
====Skin====
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
 <ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]
{{clr}}

==Differential Diagnosis of Causes of {{PAGENAME}}==

#Idiopathic: 
#*familial, 
#*possibly increased sensitivity to androgens.
#variant of normal menopause.
#Polycystic ovarian syndrome.
#obesity
#Drugs: 
#*androgens, 
#*anabolic steroids, 
#*methyltestosterone, 
#*minoxidil, 
#*diazoxide, 
#*phenytoin, 
#*glucocorticoids, 
#*cyclosporine.
#*phenytoin, 
#Congenital adrenal hyperplasia.
#Adrenal virilizing tumor.
#Ovarian virilizing tumor: 
#*arrhenoblastoma, 
#*hilus cell tumor.
#Pituitary adenoma.
#pregnancy
#Insulin resistance
#Cushing's syndrome.
#Hypothyroidism (congenital and juvenile).
#Acromegaly.
#Androgen-secreting tumors of the ovaries 
#*Sertoli-Leydig cell tumors, 
#*granulosa-theca cell tumors, 
#*hilus-cell tumors
#hyperprolactinemia
#Testicular feminization.

== Treatment ==
Many women with unwanted hair seek methods of [[hair removal]] to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.

== See also ==
* [[androgenic hair]]
* [[hypertrichosis]] 
* [[hair removal]] 

==References==
* Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. ''Journal of Clinical Endocrinology'' 1961; 21:1440-1447.


{{Diseases of the skin and subcutaneous tissue}}


[[Category:Integumentary system]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]

<!-- The below are interlanguage links. -->

<br>
[[bg:Хирзутизъм]]
[[de:Hirsutismus]]
[[et:Hirsutism]]
[[es:Hirsutismo]]
[[fr:Hirsutisme]]
[[id:Hirsutisme]]
[[nl:Hirsutisme]]
[[pl:Hirsutyzm]]
[[pt:Hirsutismo]]

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==Overview==

==Causes==
===Life Threatening Causes===

===Common Causes===

==Diagnosis==
===Focused Initial Rapid Evaluation===

===Complete Evaluation===

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==Treatment==

==Do's==

==Don'ts==

==References==
{{Reflist|2}}

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