Hirsutism differential diagnosis

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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]

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.

Differential Diagnosis

• Adrenal Tumors
• Ovarian Tumors
• Congenital Adrenal Hyperplasia
• Exogenous Androgens
• Cushing Syndrome
• Idiopathic Hirsutism
• Imaging in Polycystic Ovary Disease

Diagnosis	Incidence	Onset	Common symptom
❑ Polycystic ovary syndrome ❑ Idiopathic hirsutism ❑ Congenital adrenal hyperplasia ❑ Ovarian and androgen secreting tumors ❑ Drug induced ❑ HAIR-AN Syndrome	❑ 70-85% ❑ 5-15% ❑ 1-8% ❑ 0.3-0.1% ❑ 0.5-1% ❑ 3-4%	❑ PCOS insidious ❑ Idiopathic hirsutism Insidious ❑ CAH rapid ❑ Tumors rapid ❑ HAIRAN syndrome insidious	❑ Irregular menses, hyperandrogenism, polycystic ovary ❑ No known cause, normal ovaries, normal anbdrogens ❑ Total testosterone > 200ng and does not respond to treatment ❑ Related to medications (steroids, danazol etc) ❑ Subset of PCOS with insulin resistance and acanthosis nigricans