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| __NOTOC__ | | __NOTOC__ |
| {{Hirsutism}}
| | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hirsutism]] |
| {{CMG}} {{AE}}; {{Ochuko}}, {{RHN}}, {{AEL}} | | {{CMG}} {{AE}} {{Ochuko}}, {{RHN}}, {{AEL}} |
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| ==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]]. |
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| ==Differential Diagnosis== | | ==Differential Diagnosis== |
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| 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]].<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> | | *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> |
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| {| class="wikitable" | | {| class="wikitable" |
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| * Low [[testosterone]] levels | | * Low [[testosterone]] levels |
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| * [[Hypertension]] and [[hypokalemia]] | | * [[Hypertension]] |
| | * [[hypokalemia]] |
| * [[Virilization]] | | * [[Virilization]] |
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| * Increased [[prolactin]] | | * Increased [[prolactin]] |
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| * [[Infertility]], [[galactorrhea]] | | * [[Infertility]] |
| | * [[galactorrhea]] |
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| Hirsutism must be differentiated from other causes of irregular menses.
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| {| class="wikitable"
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| !Disease
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| !Differentiating Features
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| ![[Pregnancy]]
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| * Pregnancy always should be excluded in a patient with a history of amenorrhea
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| * Features include amenorrhea or oligomenorrhea, abnormal uterine bleeding, nausea/vomiting, cravings, weight gain (although not in the early stages and not if vomiting), polyuria, abdominal cramps and constipation, fatigue, dizziness/lightheadedness, and increased pigmentation (moles, nipples)
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| * Uterine enlargement is detectable on abdominal examination at approximately 14 weeks of gestation
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| * Ectopic pregnancy may cause oligomenorrhea, amenorrhea, or abnormal uterine bleeding with abdominal pain and sometimes subtle or absent physical symptoms and signs of pregnancy
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| !Hypothalamic amenorrhea
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| * Diagnosis of exclusion
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| * Seen in athletes, people on crash diets, patients with significant systemic illness, and those experiencing undue stress or anxiety
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| * Predisposing features are as follows weight loss, particularly if features of anorexia nervosa are present or the BMI is <19 kg/m2
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| * Recent administration of depot medroxyprogesterone, which may suppress ovarian activity for 6 months to a year
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| * Use of dopamine agonists (eg, antidepressants) and major tranquilizers
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| * Hyperthyroidism
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| * In patients with weight loss related to anorexia nervosa, fine hair growth (lanugo) may occur all over the body, but it differs from hirsutism in its fineness and wide distribution
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| ![[Primary amenorrhea]]
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| * Causes include reproductive system abnormalities, chromosomal abnormalities, or delayed puberty
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| * If secondary sexual characteristics are present, an anatomic abnormality (eg, imperforate hymen, which is rare) should be considered
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| * If secondary sexual characteristics are absent, a chromosomal abnormality (eg, Turner syndrome ) or delayed puberty should be considered
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| ![[Cushing's syndrome|Cushing syndrome]]
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| * Cushing syndrome is due to excessive glucocorticoid secretion from the adrenal glands, either primarily or secondary to stimulation from pituitary or ectopic hormones; can also be caused by exogenous steroid use
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| * Features include hypertension, weight gain (central distribution), acne, and abdominal striae Patients have low plasma sodium levels and elevated plasma cortisol levels on dexamethasone suppression testing
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| ![[Hyperprolactinemia]]
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| * Mild hyperprolactinemia may occur as part of PCOS-related hormonal dysfunction
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| * Other causes include stress, lactation, and use of dopamine antagonists
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| * A prolactinoma of the pituitary gland is an uncommon cause and should be suspected if prolactin levels are very high (>200 ng/mL)
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| * Physical examination findings are usually normal
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| * As in patients with PCOS, hyperprolactinemia may be associated with mild galactorrhea and oligomenorrhea or amenorrhea; however, galactorrhea also can occur with nipple stimulation and/or stress when prolactin levels are within normal ranges
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| * A large prolactinoma may cause headaches and visual field disturbance due to pressure on the optic chiasm, classically a gradually increasing bi-temporal hemianopsia
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| !Ovarian or adrenal tumor
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| * Benign ovarian tumors and ovarian cancer are rare causes of excessive androgen secretion; adrenocortical tumors also can increase the production of sex hormones
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| * Abdominal swelling or mass, abdominal pain due to fluid leakage or torsion, dyspareunia, abdominal ascites, and features of metastatic disease may be present
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| * Features of androgenization include hirsutism, weight gain, oligomenorrhea or amenorrhea, acne, clitoral hypertrophy, deepening of the voice, and high serum androgen (eg, testosterone, other androgens) levels
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| * In patients with an androgen-secreting tumor, serum testosterone is not suppressed by dexamethasone
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| ![[Congenital adrenal hyperplasia]]
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| * Congenital adrenal hyperplasia is a rare genetic condition resulting from 21-hydroxylase deficiency
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| * The late-onset form presents at or around menarche Patients have features of androgenization and subfertility
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| * Affects approximately 1% of hirsute patients More common in Ashkenazi Jews (19%), inhabitants of the former Yugoslavia (12%), and Italians (6%)
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| * Associated with high levels of 17-hydroxyprogesterone
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| * A short adrenocorticotropic hormone stimulation test with measurement of serum17-hydroxyprogesterone confirms the diagnosis Assays of a variety of androgenic hormones help define other rare adrenal enzyme deficiencies, which present similarly to 21-hydroxylase deficiency
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| !Anabolic steroid abuse
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| * Anabolic steroids are synthetic hormones that imitate the actions of testosterone by increasing muscle bulk and strength
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| * Should be considered if the patient is a serious sportswoman or bodybuilder
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| * Features include virilization (including acne and hirsutism), often increased muscle bulk in male pattern, oligomenorrhea or amenorrhea, clitoromegaly, gastritis, hepatic enlargement, alopecia, and aggression
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| * Altered liver function test results are seen
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| ![[Hirsutism]]
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| * Hirsutism is excessive facial and body hair, usually coarse and in a male pattern of distribution
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| * Approximately 10% of women report unwanted facial hair
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| * There is often a family history and typically some Mediterranean or Middle Eastern ancestry
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| * May also result from use of certain medications, both androgens, and others including danazol, glucocorticoids, cyclosporine, and phenytoin
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| * Menstrual history is normal
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| * When the cause is genetic, the excessive hair, especially on the face (upper lip), is present throughout adulthood, and there is no virilization
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| * When secondary to medications, the excessive hair is of new onset, and other features of virilization, such as acne and deepened voice, may be present
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| |}
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
