Hirsutism natural history, complications and prognosis: Difference between revisions
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==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
The patient's age of onset of hirsutism can be helpful in the etiologic diagnosis. | The patient's age of onset of hirsutism can be helpful in the [[etiologic]] diagnosis. | ||
* Age of onset | * Age of onset | ||
** Idiopathic hirsutism and hirsutism with benign causes usually begin at puberty. | ** [[Idiopathic]] hirsutism and hirsutism with benign causes usually begin at [[puberty]]. | ||
** Hirsutism due to adrenal or ovarian tumors usually occurs in middle-aged and older women | ** Hirsutism due to [[adrenal]] or [[ovarian]] [[tumors]] usually occurs in middle-aged and older women. | ||
* Family history: A positive family history of hirsutism is consistent with congenital adrenal hyperplasia (CAH); however, idiopathic hirsutism and polycystic ovary syndrome (PCOS) can also be familial. | * Family history: A positive family history of hirsutism is consistent with [[congenital adrenal hyperplasia]] (CAH); however, [[idiopathic]] hirsutism and [[polycystic ovary syndrome]] (PCOS) can also be familial. | ||
* Hirsutism severity and rate of progression | * Hirsutism severity and rate of progression | ||
** The benign forms of hirsutism such as hirsutism due to PCOS and idiopathic hirsutism are usually characterized by pubertal onset with slow progression over many years. | ** The benign forms of hirsutism such as hirsutism due to [[PCOS]] and idiopathic hirsutism are usually characterized by [[pubertal]] onset with slow progression over many years. | ||
** In patients with rapid and severe hirsutism or other signs of virilization, ovarian or adrenal tumors should be considered. | ** In patients with rapid and severe hirsutism or other signs of [[virilization]], [[ovarian]] or [[adrenal]] [[tumors]] should be considered. | ||
* Adrenarche and puberty | * [[Adrenarche]] and [[puberty]] | ||
** Early development of pubic hair points toward CAH, because the development of pubic hair depends on adrenal androgens | ** Early development of [[pubic hair]] points toward [[CAH]], because the development of pubic hair depends on adrenal [[androgens]] | ||
** In patients with ovarian hyperandrogenism | ** In patients with ovarian [[hyperandrogenism]] normal [[adrenarche]] and delayed [[menarche]] or irregular [[Menses|mense]]<nowiki/>s would be expected.<ref name="pmid19567450">{{cite journal |vauthors=Yildiz BO, Bolour S, Woods K, Moore A, Azziz R |title=Visually scoring hirsutism |journal=Hum. Reprod. Update |volume=16 |issue=1 |pages=51–64 |year=2010 |pmid=19567450 |pmc=2792145 |doi=10.1093/humupd/dmp024 |url=}}</ref> | ||
===Complications=== | ===Complications=== | ||
Hirsutism sometimes can lead to significant psychological distress in patients.<ref name="pmid16880018">{{cite journal |vauthors=Lipton MG, Sherr L, Elford J, Rustin MH, Clayton WJ |title=Women living with facial hair: the psychological and behavioral burden |journal=J Psychosom Res |volume=61 |issue=2 |pages=161–8 |year=2006 |pmid=16880018 |doi=10.1016/j.jpsychores.2006.01.016 |url=}}</ref> As well as the physical signs of excess hair, hirsutism can affect patients psychologically (mentally). It can cause embarrassment and affect patient's self-confidence, and therefore the quality of life.Some women feel self-conscious about having unwanted body hair or even may develop [[depression]]. Also, although hirsutism doesn't cause physical complications, the underlying cause of a hormonal imbalance can. For example if hirsutism is due to [[PCOS]] , it can lead to [[infertility]]. | Hirsutism sometimes can lead to significant [[psychological]] distress in patients.<ref name="pmid16880018">{{cite journal |vauthors=Lipton MG, Sherr L, Elford J, Rustin MH, Clayton WJ |title=Women living with facial hair: the psychological and behavioral burden |journal=J Psychosom Res |volume=61 |issue=2 |pages=161–8 |year=2006 |pmid=16880018 |doi=10.1016/j.jpsychores.2006.01.016 |url=}}</ref> As well as the physical signs of excess hair, hirsutism can affect patients psychologically (mentally). It can cause embarrassment and affect patient's self-confidence, and therefore the quality of life.Some women feel self-conscious about having unwanted body hair or even may develop [[depression]]. Also, although hirsutism doesn't cause physical complications, the underlying cause of a [[hormonal]] imbalance can. For example if hirsutism is due to [[PCOS]] , it can lead to [[infertility]]. | ||
===Prognosis=== | ===Prognosis=== | ||
Prognosis depends on the | [[Prognosis]] depends on the underlying cause. | ||
Pubertal onset hirsutism, mild hirsutism with slow progression are usually due to | [[Pubertal]] onset hirsutism, mild hirsutism with slow progression are usually due to [[benign]] causes . | ||
In cases of late onset hirsutism (in older women) , rapid and severe hirsutism with other signs of virilization ( including frontal balding, clitoromegaly, increased muscle mass, or deepening of the voice) , adrenal or ovarian tumors should be considered.<ref name="pmid19567450">{{cite journal |vauthors=Yildiz BO, Bolour S, Woods K, Moore A, Azziz R |title=Visually scoring hirsutism |journal=Hum. Reprod. Update |volume=16 |issue=1 |pages=51–64 |year=2010 |pmid=19567450 |pmc=2792145 |doi=10.1093/humupd/dmp024 |url=}}</ref> | In cases of late onset hirsutism (in older women) , rapid and severe hirsutism with other signs of [[virilization]] ( including frontal balding, [[clitoromegaly]], increased [[muscle mass]], or deepening of the voice) , [[adrenal]] or [[ovarian]] [[tumors]] should be considered.<ref name="pmid19567450">{{cite journal |vauthors=Yildiz BO, Bolour S, Woods K, Moore A, Azziz R |title=Visually scoring hirsutism |journal=Hum. Reprod. Update |volume=16 |issue=1 |pages=51–64 |year=2010 |pmid=19567450 |pmc=2792145 |doi=10.1093/humupd/dmp024 |url=}}</ref> | ||
==References== | ==References== | ||
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Overview
Natural History, Complications and Prognosis
Natural History
The patient's age of onset of hirsutism can be helpful in the etiologic diagnosis.
- Age of onset
- Idiopathic hirsutism and hirsutism with benign causes usually begin at puberty.
- Hirsutism due to adrenal or ovarian tumors usually occurs in middle-aged and older women.
- Family history: A positive family history of hirsutism is consistent with congenital adrenal hyperplasia (CAH); however, idiopathic hirsutism and polycystic ovary syndrome (PCOS) can also be familial.
- Hirsutism severity and rate of progression
- Adrenarche and puberty
- Early development of pubic hair points toward CAH, because the development of pubic hair depends on adrenal androgens
- In patients with ovarian hyperandrogenism normal adrenarche and delayed menarche or irregular menses would be expected.[1]
Complications
Hirsutism sometimes can lead to significant psychological distress in patients.[2] As well as the physical signs of excess hair, hirsutism can affect patients psychologically (mentally). It can cause embarrassment and affect patient's self-confidence, and therefore the quality of life.Some women feel self-conscious about having unwanted body hair or even may develop depression. Also, although hirsutism doesn't cause physical complications, the underlying cause of a hormonal imbalance can. For example if hirsutism is due to PCOS , it can lead to infertility.
Prognosis
Prognosis depends on the underlying cause.
Pubertal onset hirsutism, mild hirsutism with slow progression are usually due to benign causes .
In cases of late onset hirsutism (in older women) , rapid and severe hirsutism with other signs of virilization ( including frontal balding, clitoromegaly, increased muscle mass, or deepening of the voice) , adrenal or ovarian tumors should be considered.[1]
References
- ↑ 1.0 1.1 Yildiz BO, Bolour S, Woods K, Moore A, Azziz R (2010). "Visually scoring hirsutism". Hum. Reprod. Update. 16 (1): 51–64. doi:10.1093/humupd/dmp024. PMC 2792145. PMID 19567450.
- ↑ Lipton MG, Sherr L, Elford J, Rustin MH, Clayton WJ (2006). "Women living with facial hair: the psychological and behavioral burden". J Psychosom Res. 61 (2): 161–8. doi:10.1016/j.jpsychores.2006.01.016. PMID 16880018.