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Hirsutism
Hirsutism is a common medical condition and occurs in many women.
Hirsutism is the transformation of fine vellus hair to visible,
thickened terminal hair due to androgenic stimulus. Hirsutism can
be regarded as a virilizing symptom and may be defined as a male
type of body hair distribution in a woman. The change in hair growth
quality only occurs in areas where androgen responsive hair follicles
are growing. The hair growth is most frequently observed in the
beard area and on the upper lip. In some cases the hirsutism may
involve hair growth on the chest, in an inverted triangle between
the belly button and the top of the pubic hair region, and on the
lower arms and legs. There may be other symptoms in association
with hirsutism as a result of the androgenic activity such as android
obesity and acanthosis nigricans.
The most common causes of hirsutism are genetics, idiopathic, or
polycystic ovarian disease. Polycystic ovary disease is probably
the most common cause affecting between 15% and 40% of women with
hirsutism depending on which research reports you read. Idiopathic
hirsutism affects between 5% and 30% of women. For a few women,
hirsutism signals a serious underlying disorder such as an ovarian
or adrenal tumor, congenital adrenal hyperplasia, or Cushing's syndrome.
A detailed medical history and examination can identify women
in whom a serious disease is suspected and for whom laboratory evaluation
is warranted. Two specific basic screening tests should be done
on blood samples; dehydroepiandrosterone sulfate (DHEA-S) and total
free testosterone determinations. There are other tests that can
be of use in defining the disease and determining appropriate treatment,
but numerous tests are time consuming and expensive. In addition
to DHEA-S and serum testosterone, measurements of 17 alpha-hydroxyprogesterone
levels, prolactin, compound S (serum 11-deoxycortisol), follicular
stimulating hormone, and luteinizing hormone, 24-hour urinary cortisol
concentrations, and a dexamethasone suppression test can provide
useful screening data.
Patient distress is the prime indication for therapy. Therapy is
directed at suppressing ovarian or adrenal androgen production,
inhibiting the conversion of testosterone to dihydrotestosterone,
or antagonizing the effects of androgens at the receptor level.
Drug treatment should be continued for 12 months before assessing
response. Spironolactone is generally the drug tried first. Ovarian
hormones, e.g. medroxyprogesterone acetate plus ethinylestradiol,
or cyproterone acetate plus ethinylestradiol may be added if response
is inadequate.
Hirsutism
references
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