Hirsutism differential diagnosis: Difference between revisions

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__NOTOC__
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{{Hirsutism}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hirsutism]]
{{CMG}} {{AE}};{{Ochuko}}
{{CMG}} {{AE}} {{Ochuko}}, {{RHN}}, {{AEL}}


==Overview==
==Overview==
The diagnosis of hirsutism requires the exclusion of related disorders with peripheral androgen activity. Hirsutism starts shortly after puberty with a slow course and progression.
Hirsutism must be differentiated based on the different diseases causing hirsutism such as [[21-hydroxylase deficiency]], [[11β-hydroxylase deficiency|11-β hydroxylase deficiency]], [[3 beta-hydroxysteroid dehydrogenase deficiency|3 beta-hydroxysteroid dehydrogenase deficiency]], [[polycystic ovary syndrome]], [[Cushing's syndrome]], and [[hyperprolactinemia]].


==Differential Diagnosis==
==Differential Diagnosis==


{| style="cellpadding=0; cellspacing= 0; width: 600px;"
*The diagnosis of hirsutism requires the exclusion of related disorders with peripheral androgen activity.
*Hirsutism starts shortly after puberty with a slow course and progression.
*Hirsutism must be differentiated from other diseases causing excessive hair growth on the body such as [[21-hydroxylase deficiency]], [[11β-hydroxylase deficiency|11-β hydroxylase deficiency]], [[3 beta-hydroxysteroid dehydrogenase deficiency|3 beta-hydroxysteroid dehydrogenase deficiency,]] [[polycystic ovary syndrome]], [[Cushing's syndrome]], and [[hyperprolactinemia]].<ref name="pmid24830586">{{cite journal |vauthors=Hohl A, Ronsoni MF, Oliveira Md |title=Hirsutism: diagnosis and treatment |journal=Arq Bras Endocrinol Metabol |volume=58 |issue=2 |pages=97–107 |year=2014 |pmid=24830586 |doi= |url=}}</ref><ref name="pmid10857554">{{cite journal |vauthors=White PC, Speiser PW |title=Congenital adrenal hyperplasia due to 21-hydroxylase deficiency |journal=Endocr. Rev. |volume=21 |issue=3 |pages=245–91 |year=2000 |pmid=10857554 |doi=10.1210/edrv.21.3.0398 |url=}}</ref><ref name="ISBN:978-0323297387">{{cite book | last = Melmed | first = Shlomo | title = Williams textbook of endocrinology | publisher = Elsevier | location = Philadelphia, PA | year = 2016 | isbn = 978-0323297387 }}=</ref>
 
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease name
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Steroid status
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other laboratory
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Important clinical findings
|-
!Non-classic type of [[21-hydroxylase deficiency]]
|Increased:
* [[17-Hydroxyprogesterone|17-hydroxyprogesterone]]
* Exaggerated [[Androstenedione]], [[DHEA]], and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] in response to [[ACTH]]
|
* Low [[testosterone]] levels
|
* No symptoms in infancy and male
 
* [[Virilization]] in females
|-
|-
| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Diagnosis'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Incidence'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Onset'''||style="padding: 0 9px; font-size: 100%; background: #F5F5F5;" align=center | '''Common symptom'''
![[11β-hydroxylase deficiency|11-β hydroxylase deficiency]]
|Increased:
* DOC
* 11-Deoxy-[[Cortisol]]
Decreased:
* [[Cortisol]]
* [[Corticosterone]]
* [[Aldosterone]]
|
* Low [[testosterone]] levels
|
* [[Hypertension]]
* [[hypokalemia]]
* [[Virilization]]
|-
|-
| style="font-size: 90%; padding: 0 10px; background: #DCDCDC" align=left |❑ [[Polycystic ovary syndrome]] <br>
![[3 beta-hydroxysteroid dehydrogenase deficiency]]
|Increased:
* [[DHEA]]
* [[17-hydroxypregnenolone]]
* [[Pregnenolone]]
Decreased:
* [[Cortisol]]
* [[Aldosterone]]
|
* Low [[testosterone]] levels
|
* Salt-wasting [[adrenal crisis]] in infancy


❑ [[hirsutism|Idiopathic hirsutism]]<br>
* Mild [[virilization]] of genetically female infants
 
* [[Undervirilization]] of genetically male infants, making it the only form of [[CAH]] which can cause [[ambiguous genitalia]] in both genetic sexes.
❑ [[Congenital adrenal hyperplasia]] <br>
|-
 
![[Polycystic ovary syndrome ]]
❑ Ovarian and androgen secreting tumors <br>
|
 
* High [[DHEAS]] and [[androstenedione]] levels
❑ Drug induced <br>
|
 
* Low [[testosterone]] levels
❑ [[HAIR-AN Syndrome]] <br>
|
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ 70-85%<br><br> ❑ 5-15%<br><br> ❑ 1-8%<br><br>
* [[Polycystic ovaries]] in sonography
❑ 0.3-0.1%<br>
* [[Obesity]]
 
* [[PCOS]] is the most common cause of [[hirsutism]] in women
 
* No evidence another diagnosis
❑ 0.5-1% <br>
|-
 
![[Adrenal tumors]]
 
|
❑ 3-4%
* Variable levels depends on [[tumor]] type
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ PCOS insidious<br> 
|
 
* Low [[testosterone]] level
❑ Idiopathic hirsutism Insidious<br>
|
❑ CAH rapid <br><br>
* Older age
❑ Tumors rapid <br>
* Rapidly progressive symptoms
 
|-
 
!Ovarian [[virilizing]] tumor
 
|
 
* Variable levels depends on [[tumor]] type
 
|
❑ HAIRAN syndrome insidious
* [[Testosterone]] is high
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |
|
❑ Irregular menses, hyperandrogenism, polycystic ovary <br>
* Older age
❑ No other known cause, normal ovaries, normal anbdrogens <br>
* Rapidly progressive symptoms
 
|-
 
![[Cushing's syndrome]]
 
|
❑ Total testosterone > 200ng and does not respond to treatment <br>
* Increase [[cortisol]] & metabolites
 
* Variable other [[steroids]]
❑ Related to medications (steroids, danazol etc) <br>
|
 
* Variable [[mineralocorticoid]] excess
❑ Subset of PCOS with insulin resistance and acanthosis nigricans
|
* [[Cushingoid appearance]]
|-
![[Hyperprolactinemia]]
|
* Normal levels of most of [[steroids]]
|
* Increased [[prolactin]]
|
* [[Infertility]]
* [[galactorrhea]]
|}
|}


Latest revision as of 15:15, 8 December 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Rasam Hajiannasab M.D.[3], Ahmed Elsaiey, MBBCH [4]

Overview

Hirsutism must be differentiated based on the different diseases causing hirsutism such as 21-hydroxylase deficiency, 11-β hydroxylase deficiency, 3 beta-hydroxysteroid dehydrogenase deficiency, polycystic ovary syndrome, Cushing's syndrome, and hyperprolactinemia.

Differential Diagnosis

Disease name Steroid status Other laboratory Important clinical findings
Non-classic type of 21-hydroxylase deficiency Increased:
  • No symptoms in infancy and male
11-β hydroxylase deficiency Increased:

Decreased:

3 beta-hydroxysteroid dehydrogenase deficiency Increased:

Decreased:

Polycystic ovary syndrome
Adrenal tumors
  • Variable levels depends on tumor type
  • Older age
  • Rapidly progressive symptoms
Ovarian virilizing tumor
  • Variable levels depends on tumor type
  • Older age
  • Rapidly progressive symptoms
Cushing's syndrome
Hyperprolactinemia

References

  1. ↑ Hohl A, Ronsoni MF, Oliveira M (2014). "Hirsutism: diagnosis and treatment". Arq Bras Endocrinol Metabol. 58 (2): 97–107. PMID 24830586. Vancouver style error: initials (help)
  2. ↑ White PC, Speiser PW (2000). "Congenital adrenal hyperplasia due to 21-hydroxylase deficiency". Endocr. Rev. 21 (3): 245–91. doi:10.1210/edrv.21.3.0398. PMID 10857554.
  3. ↑ Melmed, Shlomo (2016). Williams textbook of endocrinology. Philadelphia, PA: Elsevier. ISBN 978-0323297387.=

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