Hirsutism history and symptoms

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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

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.

History and Symptoms

History

A good and accurate history of the onset and developmental milestones are important and useful in making a diagnosis of hirsutism.

• Age of Onset
  • During puberty, idiopathic hirsutism and other less serious causes of hirsutism usually begins.
  • Hirsutism in middle-aged or older women may suggest an adrenal or ovarian tumor.

• Family History: Congenital adrenal hyperplasia (CAH) in a patient with a family history of hirsutism is consistent with the diagnosis. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) could also be familial and maybe suggestive in making a diagnosis.

• Hirsutism severity and rate of progression
  • A benign form of hirsutism is usually characterized by pubertal onset with slow progression over many years. This is often true of hirsutism with PCOS.
  • An androgen-secreting tumor is a possibility with a history of rapid severe hirsutism or other signs of virilization.

• Adrenarche and Puberty: Early development of pubic hair is a pointer towards CAH.

Symptoms

• Virilizing signs such as;
  • Change in voice or deepening voice
  • Male pattern baldness
  • Clitoromegaly (enlargement of the clitoris)
  • Increased muscle mass
  • Acne
  • Decreased breast size (small breasts)
• Amenorrhea
• Increase in libido
• Signs of insulin resistance (eg. acanthosis nigricans, abdominal obesity)