Hirsutism natural history, complications and prognosis

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

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Natural History, Complications and Prognosis

Natural History

• Age of onset
  • Idiopathic hirsutism and the other less-serious causes of hirsutism usually begin at puberty.
  • Hirsutism that occurs in middle-aged or older women may suggest an adrenal or ovarian tumor.
• Family history: A patient with a family history of hirsutism is consistent with CAH; however, idiopathic hirsutism and polycystic ovary syndrome (PCOS) can also be familial.
  • Hirsutism severity and rate of progression
    • The history of 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.
    • When a history of rapid severe hirsutism or other signs of virilization are obtained, an androgen-secreting tumor is a possibility.
  • Adrenarche and puberty
    • Because the development of pubic hair depends on adrenal androgens, early development points toward CAH.
    • In contrast, ovarian hyperandrogenism is associated with normal adrenarche and delayed menarche or irregular menses.

Prognosis

Prognosis depends on the underlynig cause of the hirsutism and whether it is benign or malignant.