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==Physical Examination==
==Physical Examination==
The first part of physical examination is to quantitate the hirsutism . The common method to quantitate hirsutism is using Ferriman and Gallwey.
* The grade for each area ranges from 0 (no terminal hair) to 4 (frankly virile).
* The body areas used to grade hirsutism are (1) the upper lip, (2) chin, (3) chest, (4) leg, (5) thigh, (6) upper arm, (7) forearm, (8) upper back, (9) lower back, (10), upper abdomen, and (11) lower abdomen.
* Areas such as the axilla and pubis are not included because terminal hair grows in these places at normal androgen levels in women.
* A woman with a score of 8 or higher is considered to have hirsutism. Most women who seek medical attention for the disorder have scores of 15 or higher. Normal scores have also been established for Turkey (up to 11) and Thailand (up to 3 on the modified Ferriman and Gallwey scale).


* In women with moderate-to-severe hirsutism (score >15), seek additional signs of [[hyperandrogenism]], including (1) temporal hair recession, (2) oily skin, (3) [[masculine]] voice, (4) well-developed [[musculature]], (5) enlargement of the [[clitoris]] (>35 mm <sup>2</sup> in surface area), (6) irregular [[menses]], and (7) psychological changes (eg, heightened [[libido]], aggressiveness).
*  
* The degree to which these clinical factors are present suggests the level of [[androgen]] overproduction and, thus, helps to determine the degree of concern for the presence of an underlying disease.
* The extent of the evaluation for the cause of hirsutism is greater in women who have more severe clinical evidence of [[masculinization]].
* A thorough [[abdominal]] and [[pelvic]] examination is important in patients with hirsutism because more than half of androgen-secreting [[Adrenal gland|adrenal]] and [[ovarian tumor]]<nowiki/>s are palpable.
* Examine the skin for [[acanthosis nigricans]], a manifestation of [[insulin resistance]].
* Women with hirsutism are usually [[obese]], with increased waist-hip ratios, and are thought to be at an increased risk for [[atherosclerosis]] and [[coronary heart disease]]. They also have increased [[bone mineral density]] scores at the hip and spine. These increases correlate with higher levels of serum free [[testosterone]] and [[estrogen]]<ref name="urlHirsutism Clinical Presentation: History, Physical, Causes">{{cite web |url=http://emedicine.medscape.com/article/121038-clinical#b4 |title=Hirsutism Clinical Presentation: History, Physical, Causes |format= |work= |accessdate=}}</ref>
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism  (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism  (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
  <ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]                                                                                                          [[Image:dmr04202.gif]]<ref name="urloup.silverchair-cdn.com">{{cite web |url=https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/humupd/18/2/10.1093/humupd/dmr042/2/dmr04202.gif?Expires=1505503837&Signature=YNA1iDXSklTyJBYsNtKSfrrHw2cz4yxRQ1-~56gRM2krKI~~heM-nwS9fP0Ip5HO7SNWEGIk1iXcO8cuS-ZGQScsFqHsMcJkvyYz9pzBA5NTMVnxZyDsuh9BWOym4aFC0bPB7gA9LcuoL7lnTvbo9hj7bWhQEWH2gYsrYikGEG8HnPaplCHCCgcA33b0PB2h1T5IxFLh0IjR8oe2zZrAfVl6CYcvfekd04WOEfJVL1zs86a5w~u7UejPqAicAiu-zA58zb2EcGljxArckvsEmrF6vcTdUyA8i-pxBZbohlXtie8Jrqw9wVIUfADKzLEqXxEr8FRzvcPg31Ne5l1sOA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q |title=oup.silverchair-cdn.com |format= |work= |accessdate=}}</ref>                     
  <ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]                                                                                                          [[Image:dmr04202.gif]]<ref name="urloup.silverchair-cdn.com">{{cite web |url=https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/humupd/18/2/10.1093/humupd/dmr042/2/dmr04202.gif?Expires=1505503837&Signature=YNA1iDXSklTyJBYsNtKSfrrHw2cz4yxRQ1-~56gRM2krKI~~heM-nwS9fP0Ip5HO7SNWEGIk1iXcO8cuS-ZGQScsFqHsMcJkvyYz9pzBA5NTMVnxZyDsuh9BWOym4aFC0bPB7gA9LcuoL7lnTvbo9hj7bWhQEWH2gYsrYikGEG8HnPaplCHCCgcA33b0PB2h1T5IxFLh0IjR8oe2zZrAfVl6CYcvfekd04WOEfJVL1zs86a5w~u7UejPqAicAiu-zA58zb2EcGljxArckvsEmrF6vcTdUyA8i-pxBZbohlXtie8Jrqw9wVIUfADKzLEqXxEr8FRzvcPg31Ne5l1sOA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q |title=oup.silverchair-cdn.com |format= |work= |accessdate=}}</ref>                     

Revision as of 17:24, 15 September 2017

Hirsutism Microchapters

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Overview

Historical Perspective

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Causes

Differentiating Hirsutism from other Diseases

Epidemiology and Demographics

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Natural History, Complications and Prognosis

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Physical Examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Overview

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.

Physical Examination

hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor) [1]

[2]

Upper lip 0-4
Chin 0-4
Chest 0-4
Leg 0-4
Thigh 0-4
Upper arm 0-4
Forearm 0-4
Upper back 0-4
Lower back 0-4
Upper abdomen 0-4
Lower abdomen 0-4

References

  1. ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages/
  2. ↑ "oup.silverchair-cdn.com".

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