Hirsutism overview: Difference between revisions
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Hirsutism Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Hirsutism overview On the Web |
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
Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical indication, especially if it develops well after puberty.
It affects 5-15% of women . In most of the cases there is an underlying hormonal imbalance . Excessive amount of androgen plays a major role, as 70% of patients with excessive androgen will develop hirsutism. However in 5 to 15% of patients suffering from hirsutism , there is no increase in androgen level and are considered as idiopathic hirsutism. About 50% of hirsutism cases have high androgen level. Free testosterone is the main circulating androgen and is often elevated in hirsute women and the level of androgens and hair follicle sensitivity to androgens play the major role .[1] Ovulatory dysfunction (PCOs), diabetes, thyroid hormone abnormalities and CAH are some of the underlying causes for hirsutism.[2]
There is a scoring system which is called Ferriman–Gallwey scale, which quantitates the extent of hair growth in the most androgen-sensitive sites and patients with a score of 8 or more ,would be considered a hirstue .Hirsutism must be distinguished from hypertrichosis which is a result of either heredity or the use of medications such as glucocorticoids, phenytoin, minoxidil, or cyclosporine. Hypertrichosis is not caused by excess androgen.[2]
Pubertal onset hirsutism specially when it is mild ,points toward PCOS or idiopathic hirsutism but sever late onset hirsutim with other virlization signs can be due to ovarian or adrenal tumors. Hirsutism can lead to significant psychological distress for women and even depression if left untreated and based on the underlying cause other medical complications can occur (e.g. in cases of hirsutism due to PCOS , if the treatment doesn't address PCOS , it can lead to infertility.) Prognosis depend on underlying etiology .
Treatment options include: Cosmetic and hormonal therapy .Cosmetic therapy includes shaving, waxing , laser hair removal therapy , etc. Hormonal therapy includes : oral contraceptives, finestride , spironolactone ,etc.
Historical Perspective
Throughout the history hirsutism has been regarded as a syndrome of hair growth in women in a male pattern , obesity and menstural irregularity (Apert, 1910) . Other authors considered hirsutism as masculine hair growth only(Howard and Whitehill, 1937; Glass and Bergman, 1938). Hirsutism has been the most outstanding symptom in virilism and masculinization and also the major feature of adreno-genital syndrome which was introduced in 1905 by Bulloch and Sequiera.[3]
Classification
Hirsutism is classified using 11 body areas to assess hair growth using the Ferriman–Gallwey score, a method of evaluating and quantifying hirsutism in women.
Pathophysiology
Hirsutism is a common disorder of the endocrine system, which affects about 10% of women approximately in the United States. It may indicate a serious or unserious medical condition seen as a serious cosmetic problem. Androgens are required for sexual hair development. Hirsutism can arise from increased androgen production or from increased sensitivity of the hair follicles to circulating androgens. [4]
Causes
The cause of hirsutism can be either an increased level of androgens (male hormones) 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 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.
Differentiating Hirsutism from Other Diseases
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.
Epidemiology and Demographics
Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.
Risk Factors
Several factors increase the risk of developing hirsutism and an accurate history would aid in accurately identifying the risk.
Screening
Screening in all hirsute women should be done in order to detect possible malignant and concerning underlying causes .
Natural History, Complications, and Prognosis
Pubertal onset hirsutism specially when it is mild ,points toward PCOS or idiopathic hirsutism but sever late onset hirsutim with other virlization signs can be due to ovarian or adrenal tumors. Hirsutism can lead to significant psychological distress for women and even depression if left untreated and based on the underlying cause other medical complications can occur (e.g. in cases of hirsutism due to PCOS , if the treatment doesn't address PCOS , it can lead to infertility.) Prognosis depend on underlying etiology .
Diagnosis
Diagnostic Criteria
History and Symptoms
Hirsutism affects members of any gender, since rising androgen levels can cause excessive body hair, particularly in locations where women normally do not develop terminal hair during puberty (chest, abdomen, back, and face). Signs that are suggestive of an androgen-secreting tumor in a patient with hirsutism is rapid onset, virilization and palpable abdominal mass.
Physical Examination
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.
Laboratory Findings
It is important to carry out various biochemical tests to determine the cause of hirsutism that is necessary to make an informed decision for the best options for treatment.
Electrocardiogram
There is no EKG findings associated associated with hirsutism.
X-ray
There are no chest X ray findings associated with hirsutism.
Ultrasound
CT scan
Computed tomography can be beneficial in detecting the underlying cause of hirsutism.
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ Schmoldt A, Benthe HF, Haberland G, Voigt R, Krause W, Voigt P (1975). "Digitoxin metabolism by rat liver microsomes". Biochem. Pharmacol. 24 (17): 1639–41. PMID 10.
- ↑ 2.0 2.1 Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
- ↑ "CHAPTER I: A Clinical and Historical Review of Hirsutism, Cushing's Syndrome and Precocious Puberty". Acta Medica Scandinavica. 116 (S149): 1–9. 2009. doi:10.1111/j.0954-6820.1944.tb01683.x. ISSN 0001-6101.
- ↑ Breckwoldt M, Zahradnik HP, Wieacker P (1989). "Hirsutism, its pathogenesis". Hum Reprod. 4 (6): 601–4. PMID 2674189.