Hirsutism causes: Difference between revisions

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==Overview==
==Overview==
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.
The cause of hirsutism can be either an increased level of [[androgen]]s (male [[hormone]]s) or an oversensitivity of [[hair follicles]] to androgens, and the most common cause is [[polycystic ovary syndrome]]. 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.


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*There are no known life threatening causes of hirsutism.


===Common Causes===
===Common Causes===
*[[tumor|Androgen secreting tumors]] <ref name="pmid20198556">{{cite journal| author=Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B et al.| title=Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature. | journal=Exp Clin Endocrinol Diabetes | year= 2010 | volume= 118 | issue= 5 | pages= 291-7 | pmid=20198556 | doi=10.1055/s-0029-1225351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20198556  }} </ref>
*[[Congenital adrenal hyperplasia]]
*[[Congenital adrenal hyperplasia]]
*[[Cushing's syndrome]]
*[[Cushing's syndrome]]
*[[hirsutism|Idiopathic hirsutism]]
*[[hirsutism|Idiopathic hirsutism]]
*[[tumor|Androgen secreting tumors]]
*[[Polycystic ovary syndrome]] <ref name="pmid14764747">{{cite journal |vauthors=Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR |title=Androgen excess in women: experience with over 1000 consecutive patients |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=2 |pages=453–62 |year=2004 |pmid=14764747 |doi=10.1210/jc.2003-031122 |url=}}</ref>
*[[Polycystic ovary syndrome|PCOs]] <ref name="pmid14764747">{{cite journal |vauthors=Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR |title=Androgen excess in women: experience with over 1000 consecutive patients |journal=J. Clin. Endocrinol. Metab. |volume=89 |issue=2 |pages=453–62 |year=2004 |pmid=14764747 |doi=10.1210/jc.2003-031122 |url=}}</ref>


===Causes by Organ System===
===Causes by Organ System===
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{| style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
| style="width:75%" bgcolor="Beige" ; border="1" | [[Insulin resistance syndrome]]
|-
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[Dermatomyositis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
| bgcolor="Beige" |
| bgcolor="Beige" |[[Aripiprazole]], [[bimatoprost]], [[bupropion]], [[carbamazepine]], [[clonazepam]], [[corticosteroids]], [[cyclosporine]], [[danazol]], [[dantrolene]], [[desogestrel and ethinyl estradiol]], [[dexamethasone]], [[diazoxide]], [[donepezil]], [[estrogens]], [[eszopiclone]], [[ethosuximide]], [[ethotoin]], [[ethynodiol diacetate and ethinyl estradiol]], [[fluoxetine]], [[fluoxymesterone]], [[gestrinone]], [[pegylated interferon alfa-2a|interferon alfa]], [[isotretinoin]], [[lamotrigine]], [[leuprolide]], [[methyltestosterone]], [[mycophenolate]], [[olanzapine]], [[oxandrolone]], [[oxymetholone]], [[paroxetine]], [[phenytoin]], [[prednisolone]], [[pregabalin]], [[progestin]], [[selegiline]], [[tacrolimus]], [[testosterone]], [[tiagabine]], [[trazodone]], [[valproic acid]], [[vasodilators]], [[venlafaxine]], [[zonisamide]]  
* [[Desogestrel]]  
*  [[Estradiol|Ethinyl Estradiol]]
 
*[[Dexamethasone]]
*[[Ethosuximide]]
*[[Ethynodiol diacetate and ethinyl estradiol]]
*[[Fluoxymesterone]]
*[[Conjugated estrogens]]
*[[Cyclosporin]]
*[[Methyltestosterone]]
*[[Oxandrolone]]
*[[Oxymetholone]]
*[[Prednisolone]]
*[[Tiagabine]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
| bgcolor="Beige" |
| bgcolor="Beige" |[[Acromegaly]], [[adrenal adenoma]], [[adrenal carcinoma]], [[adrenal tumor]], [[arrhenoblastoma]], [[congenital adrenal hyperplasia]], [[Cushing syndrome]], [[Cushing's disease]], [[hyperprolactinemia]], [[hypothyroidism]], [[insulin resistance syndrome]], [[luteoma]], [[pituitary tumor]], [[polycystic ovary syndrome]], [[porphyria cutanea tarda]], [[Stein-Leventhal syndrome]], [[testosterone]]  
* [[PCOS]]
* [[CAH]]
* [[Cushing's syndrome|Cushing syndrome]]
* [[Adrenal tumor|Adrenal tumors]]
* [[Ovarian tumor]]
* [[Insulin resistance]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
| bgcolor="Beige" |
| bgcolor="Beige" |[[11β-hydroxylase deficiency]], [[21-hydroxylase deficiency]], [[Achard-Thiers syndrome]], [[alpha-L-iduronidase deficiency]], [[Ambras syndrome]], [[Coffin-Siris syndrome]], [[congenital adrenal hyperplasia]], [[Cornelia de Lange Syndrome]], [[Hurler syndrome]], [[hypertrichosis lanuginosa]], [[Miller-Dieker syndrome]], [[nodulosis-arthropathy-osteolysis syndrome]], [[Turner syndrome]]  
* [[Idiopathic]] hirsutism
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[Alpha-L-iduronidase deficiency]], [[cortisone reductase deficiency]], [[Hurler syndrome]], [[i-cell disease]], [[porphyria cutanea tarda]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" |
| bgcolor="Beige" |[[Ovarian cancer]], ovarian hyperthecosis, [[ovarian tumor]], [[polycystic ovary syndrome]], [[Stein-Leventhal syndrome]]  
* [[PCOS]]
* [[Ovarian tumor]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[Adrenal adenoma]], [[adrenal carcinoma]], [[adrenal tumor]], [[arrhenoblastoma]], [[luteoma]], [[ovarian cancer]], [[ovarian tumor]], [[pituitary tumor]], [[testicular tumor]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[Dermatomyositis]], [[insulin resistance syndrome]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[Ovarian cancer]], ovarian hyperthecosis, [[ovarian tumor]], [[polycystic ovary syndrome]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" | [[hirsutism|Idiopathic hirsutism]]
|-
|-
|}
|}


===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
 
{{columns-list|
 
*[[11β-hydroxylase deficiency]]
The following may be some of the conditions that may increase a woman's normally low level of male hormones:
*[[21-hydroxylase deficiency]]
 
*[[Achard-Thiers syndrome]]
{{columns-list|3|
*[[Acromegaly]]
* [[Adrenal gland|Adrenal gland tumors]]
*[[Adrenal adenoma]]
* [[Polycystic ovary syndrome]]  
*[[Adrenal carcinoma]]
* [[Cushing's disease]]  
*[[Adrenal tumor]]
* [[Desogestrel and Ethinyl Estradiol]]
*[[Alpha-L-iduronidase deficiency]]
* [[Dexamethasone]]
*[[Ambras syndrome]]
* [[Ethosuximide]]
*[[Aripiprazole]]
* [[Ethynodiol diacetate and ethinyl estradiol]]
*[[Arrhenoblastoma]]
* [[Fluoxymesterone]]
*[[Bimatoprost]]
* [[Congenital adrenal hyperplasia]]
*[[Bupropion]]
* [[Conjugated estrogens]]
*[[Carbamazepine]]
* [[Cyclosporin]]
*[[Clonazepam]]
* [[Insulin resistance]]
*[[Coffin-Siris syndrome]]
* [[Methyltestosterone]]
*[[Congenital adrenal hyperplasia]]
* [[Ovarian tumor]]s
*[[Cornelia de Lange Syndrome]]
* [[Oxandrolone]]
*[[Corticosteroids]]
* [[Oxymetholone]]
*[[Cortisone reductase deficiency]]
* [[Prednisolone]]
*[[Cushing syndrome]]
* [[Tiagabine]]
*[[Cushing's disease]]
*[[Cyclosporine]]
*[[Danazol]]
*[[Dantrolene]]
*[[Dermatomyositis]]
*[[Desogestrel and ethinyl estradiol]]
*[[Dexamethasone]]
*[[Diazoxide]]
*[[Donepezil]]
*[[Estrogens]]
*[[Eszopiclone]]
*[[Ethosuximide]]
*[[Ethotoin]]
*[[Ethynodiol diacetate and ethinyl estradiol]]
*[[Fluoxetine]]
*[[Fluoxymesterone]]
*[[Gestrinone]]
*[[Hurler syndrome]]
*[[Hyperprolactinemia]]
*[[Hypertrichosis lanuginosa]]
*[[Hypothyroidism]]
*[[I-cell disease]]
*[[hirsutism|Idiopathic hirsutism]]
*[[Insulin resistance syndrome]] <ref name="pmid20198556">{{cite journal| author=Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B et al.| title=Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature. | journal=Exp Clin Endocrinol Diabetes | year= 2010 | volume= 118 | issue= 5 | pages= 291-7 | pmid=20198556 | doi=10.1055/s-0029-1225351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20198556  }} </ref>
*[[Pegylated interferon alfa-2a|Interferon alfa]]
*[[Isotretinoin]]
*[[Lamotrigine]]
*[[Leuprolide]]
*[[Luteoma]]
*[[Methyltestosterone]]
*[[Miller-Dieker syndrome]]
*[[Mycophenolate]]
*[[Nodulosis-arthropathy-osteolysis syndrome]]
*[[Olanzapine]]
*[[Ovarian cancer]]
*Ovarian hyperthecosis <ref name="pmid2062784">{{cite journal| author=Goldman JM, Kapadia LJ| title=Virilization in a postmenopausal woman due to ovarian stromal hyperthecosis. | journal=Postgrad Med J | year= 1991 | volume= 67 | issue= 785 | pages= 304-6 | pmid=2062784 | doi= | pmc=2399029 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2062784  }} </ref>
*[[Ovarian tumor]]
*[[Oxandrolone]]
*[[Oxymetholone]]
*[[Paroxetine]]
*[[Phenytoin]]
*[[Pituitary tumor]]
*[[Polycystic ovary syndrome]]
*[[Porphyria cutanea tarda]]
*[[Prednisolone]]
*[[Pregabalin]]
*[[Progestin]]
*[[Selegiline]]
*[[Insulin resistance syndrome]]
*[[Stein-Leventhal syndrome]]
*[[Tacrolimus]]
*[[Testicular tumor]]
*[[Testosterone]]
*[[Tiagabine]]
*[[Trazodone]]
*[[Turner syndrome]]
*[[Valproic acid]]
*[[Vasodilators]]
*[[Venlafaxine]]
*[[Zonisamide]]
}}
}}


Latest revision as of 15:13, 8 December 2020

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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]

Overview

The cause of hirsutism can be either an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgens, and the most common cause is polycystic ovary syndrome. 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 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.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

  • There are no known life threatening causes of hirsutism.

Common Causes

Causes by Organ System

Cardiovascular Insulin resistance syndrome
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Dermatomyositis
Drug Side Effect Aripiprazole, bimatoprost, bupropion, carbamazepine, clonazepam, corticosteroids, cyclosporine, danazol, dantrolene, desogestrel and ethinyl estradiol, dexamethasone, diazoxide, donepezil, estrogens, eszopiclone, ethosuximide, ethotoin, ethynodiol diacetate and ethinyl estradiol, fluoxetine, fluoxymesterone, gestrinone, interferon alfa, isotretinoin, lamotrigine, leuprolide, methyltestosterone, mycophenolate, olanzapine, oxandrolone, oxymetholone, paroxetine, phenytoin, prednisolone, pregabalin, progestin, selegiline, tacrolimus, testosterone, tiagabine, trazodone, valproic acid, vasodilators, venlafaxine, zonisamide
Ear Nose Throat No underlying causes
Endocrine Acromegaly, adrenal adenoma, adrenal carcinoma, adrenal tumor, arrhenoblastoma, congenital adrenal hyperplasia, Cushing syndrome, Cushing's disease, hyperprolactinemia, hypothyroidism, insulin resistance syndrome, luteoma, pituitary tumor, polycystic ovary syndrome, porphyria cutanea tarda, Stein-Leventhal syndrome, testosterone
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic 11β-hydroxylase deficiency, 21-hydroxylase deficiency, Achard-Thiers syndrome, alpha-L-iduronidase deficiency, Ambras syndrome, Coffin-Siris syndrome, congenital adrenal hyperplasia, Cornelia de Lange Syndrome, Hurler syndrome, hypertrichosis lanuginosa, Miller-Dieker syndrome, nodulosis-arthropathy-osteolysis syndrome, Turner syndrome
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Alpha-L-iduronidase deficiency, cortisone reductase deficiency, Hurler syndrome, i-cell disease, porphyria cutanea tarda
Obstetric/Gynecologic Ovarian cancer, ovarian hyperthecosis, ovarian tumor, polycystic ovary syndrome, Stein-Leventhal syndrome
Oncologic Adrenal adenoma, adrenal carcinoma, adrenal tumor, arrhenoblastoma, luteoma, ovarian cancer, ovarian tumor, pituitary tumor, testicular tumor
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Dermatomyositis, insulin resistance syndrome
Sexual Ovarian cancer, ovarian hyperthecosis, ovarian tumor, polycystic ovary syndrome
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Idiopathic hirsutism

Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B; et al. (2010). "Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature". Exp Clin Endocrinol Diabetes. 118 (5): 291–7. doi:10.1055/s-0029-1225351. PMID 20198556.
  2. ↑ Azziz R, Sanchez LA, Knochenhauer ES, Moran C, Lazenby J, Stephens KC, Taylor K, Boots LR (2004). "Androgen excess in women: experience with over 1000 consecutive patients". J. Clin. Endocrinol. Metab. 89 (2): 453–62. doi:10.1210/jc.2003-031122. PMID 14764747.
  3. ↑ Goldman JM, Kapadia LJ (1991). "Virilization in a postmenopausal woman due to ovarian stromal hyperthecosis". Postgrad Med J. 67 (785): 304–6. PMC 2399029. PMID 2062784.

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