Hirsutism

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 18 HIRSUTISM

Theodore O’Connell

Hirsutism is defined as the presence of excessive coarse terminal hair in a pattern not normal in women in areas such as the face, chest, or upper abdomen. This disorder is a sign of increased androgen action on hair follicles, which may result from increased levels of endogenous or exogenous androgens or from increased sensitivity of hair follicles to normal levels of circulating androgens.

In evaluating hirsutism, it is important to determine whether hirsutism exists alone or whether virilization is also present. This distinction is important because virilization may reflect a serious underlying pathologic condition, such as malignancy. Virilization manifests with a wide range of signs of androgen excess in addition to hirsutism, such as acne, frontotemporal balding, amenorrhea, oligomenorrhea, deepening of the voice, and clitoromegaly.

The most common triggering mechanism for hirsutism is excess androgen production. Although androgens may come from an exogenous source, androgen excess is most commonly endogenous. The two primary sources of endogenous androgens are the adrenal glands and the ovaries. Adrenal gland–related causes include congenital adrenal hyperplasia, Cushing syndrome, or tumor. Ovarian causes include polycystic ovary syndrome and tumors.

Medications Linked to Hirsutism

Anabolic steroids

Progestins (especially levonorgestrel, norethindrone, and norgestrel)

Causes of Hirsutism

Congenital adrenal hyperplasia

Cushing syndrome

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