Hirsutism physical examination: Difference between revisions

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{{Hirsutism}}
{{Hirsutism}}
{{CMG}} {{AE}}
{{CMG}}: {{AE}}; {{RHN}}, {{AY}}
 
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==Overview==
==Overview==
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.
Patients with hirsutism usually appear normal and in no acute distress. The degree of hirsutism can be estimated using the [[Ferriman-Gallwey score]].


==Physical Examination==
==Physical Examination==
The first part of physical examination is to quantitate the hirsutism . The common method to quantitate hirsutism is using Ferriman and Gallwey.
* The grade for each area ranges from 0 (no terminal hair) to 4 (frankly virile).
* The body areas used to grade hirsutism are (1) the upper lip, (2) chin, (3) chest, (4) leg, (5) thigh, (6) upper arm, (7) forearm, (8) upper back, (9) lower back, (10), upper abdomen, and (11) lower abdomen.
* Areas such as the axilla and pubis are not included because terminal hair grows in these places at normal androgen levels in women.
* A woman with a score of 8 or higher is considered to have hirsutism. Most women who seek medical attention for the disorder have scores of 15 or higher. Normal scores have also been established for Turkey (up to 11) and Thailand (up to 3 on the modified Ferriman and Gallwey scale).


* In women with moderate-to-severe hirsutism (score >15), seek additional signs of [[hyperandrogenism]], including (1) temporal hair recession, (2) oily skin, (3) [[masculine]] voice, (4) well-developed [[musculature]], (5) enlargement of the [[clitoris]] (>35 mm <sup>2</sup> in surface area), (6) irregular [[menses]], and (7) psychological changes (eg, heightened [[libido]], aggressiveness).
===General===
* The degree to which these clinical factors are present suggests the level of [[androgen]] overproduction and, thus, helps to determine the degree of concern for the presence of an underlying disease.
Patients with hirsutism usually appear normal and in no acute distress. The degree of hirsutism can be estimated using the Ferriman-Gallwey score.<ref name="Rosenfield2005">{{cite journal|last1=Rosenfield|first1=Robert L.|title=Hirsutism|journal=New England Journal of Medicine|volume=353|issue=24|year=2005|pages=2578–2588|issn=0028-4793|doi=10.1056/NEJMcp033496}}</ref>
* The extent of the evaluation for the cause of hirsutism is greater in women who have more severe clinical evidence of [[masculinization]].
===Appearance===
* A thorough [[abdominal]] and [[pelvic]] examination is important in patients with hirsutism because more than half of androgen-secreting [[Adrenal gland|adrenal]] and [[ovarian tumor]]<nowiki/>s are palpable.
*Patients with hirsutism usually appear normal and in no acute distress.
* Examine the skin for [[acanthosis nigricans]], a manifestation of [[insulin resistance]].
===Skin===
* Women with hirsutism are usually [[obese]], with increased waist-hip ratios, and are thought to be at an increased risk for [[atherosclerosis]] and [[coronary heart disease]]. They also have increased [[bone mineral density]] scores at the hip and spine. These increases correlate with higher levels of serum free [[testosterone]] and [[estrogen]]<ref name="urlHirsutism Clinical Presentation: History, Physical, Causes">{{cite web |url=http://emedicine.medscape.com/article/121038-clinical#b4 |title=Hirsutism Clinical Presentation: History, Physical, Causes |format= |work= |accessdate=}}</ref>
*generalized increase in growth of the hair on all of the body (hypertrichosis).<ref name="Rosenfield2005">{{cite journal|last1=Rosenfield|first1=Robert L.|title=Hirsutism|journal=New England Journal of Medicine|volume=353|issue=24|year=2005|pages=2578–2588|issn=0028-4793|doi=10.1056/NEJMcp033496}}</ref>
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism  (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
*The skin of the abdomen may show striae in the cases of Cushing syndrome.
<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]
{| class="wikitable"
{| class="wikitable"
!Upper lip
!Upper lip
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|-
|-
!Chest
!Chest
!0-4
!0-4                                                                                                                                              
|-
|-
!Leg
!Leg
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|}
|}
{{clr}}
{{clr}}
[[Image:CushingsFace.jpg|400px|center|thumb|A patient with Cushing disease and hirsutism - By Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu - http://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-7-26, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=47877333 ]]
===Neck===
*The neck is usually supple without any masses.
===Lungs===
*The lungs are usually clear to auscultation.
===Abdomen===
*Inspection may show central obesity if Cushing syndrome is present.<ref name="pmid12825846">{{cite journal |vauthors=Hunter MH, Carek PJ |title=Evaluation and treatment of women with hirsutism |journal=Am Fam Physician |volume=67 |issue=12 |pages=2565–72 |year=2003 |pmid=12825846 |doi= |url=}}</ref>
*Palpation of the abdomen may reveal masses in the iliac fossae if PCO is the cause of hirsutism.
===Heart===
*Auscultation of the heart reveals normal S1, S2, with no rubs, gallops, or murmurs.
===Extremities===
*The extremities may show wasting in the cases of Cushing syndrome.
===Neurologic===
*Patient is usually oriented to time, person, and place with average motor and sensory functions.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Endocrinology]]
[[Category:Integumentary system]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]
{{WH}}
{{WS}}

Latest revision as of 13:43, 10 October 2017

Hirsutism Microchapters

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Overview

Historical Perspective

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Causes

Differentiating Hirsutism from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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Physical Examination

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Risk calculators and risk factors for Hirsutism physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: ; Rasam Hajiannasab M.D.[2], Ahmed Younes M.B.B.CH [3]

Overview

Patients with hirsutism usually appear normal and in no acute distress. The degree of hirsutism can be estimated using the Ferriman-Gallwey score.

Physical Examination

General

Patients with hirsutism usually appear normal and in no acute distress. The degree of hirsutism can be estimated using the Ferriman-Gallwey score.[1]

Appearance

  • Patients with hirsutism usually appear normal and in no acute distress.

Skin

  • generalized increase in growth of the hair on all of the body (hypertrichosis).[1]
  • The skin of the abdomen may show striae in the cases of Cushing syndrome.
Upper lip 0-4
Chin 0-4
Chest 0-4
Leg 0-4
Thigh 0-4
Upper arm 0-4
Forearm 0-4
Upper back 0-4
Lower back 0-4
Upper abdomen 0-4
Lower abdomen 0-4
A patient with Cushing disease and hirsutism - By Ozlem Celik, Mutlu Niyazoglu, Hikmet Soylu and Pinar Kadioglu - http://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-7-26, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=47877333

Neck

  • The neck is usually supple without any masses.

Lungs

  • The lungs are usually clear to auscultation.

Abdomen

  • Inspection may show central obesity if Cushing syndrome is present.[2]
  • Palpation of the abdomen may reveal masses in the iliac fossae if PCO is the cause of hirsutism.

Heart

  • Auscultation of the heart reveals normal S1, S2, with no rubs, gallops, or murmurs.

Extremities

  • The extremities may show wasting in the cases of Cushing syndrome.

Neurologic

  • Patient is usually oriented to time, person, and place with average motor and sensory functions.

References

  1. ↑ 1.0 1.1 Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
  2. ↑ Hunter MH, Carek PJ (2003). "Evaluation and treatment of women with hirsutism". Am Fam Physician. 67 (12): 2565–72. PMID 12825846.
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