Hirsutism

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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166 Hirsutism

Instruction

Examine this patient.

Salient features

History

• Age of onset

• Rate of progression of hirsutism

• History of thinning of scalp hair, or deepening of voice

• History of obesity

• Drug history: corticosteroids, androgen, phenytoin, minoxidil, diazoxide, ciclosporin

• Take a menstrual history: oligomenorrhoea, infertility, acne, seborrhoea or voice change suggest polycystic ovaries

• Family history (familial).

Examination

• Excessive hair growth, particularly over the face (Fig. 166.1) and upper and lower limbs.

Note: The amount and distribution of hair is an index of androgen effect. Terminal hairs on the face, around the areolae or on the lower abdomen or lower back may be normal, but hair on the upper back, shoulders and upper abdomen suggests a more marked increase in androgen production.
image

Fig. 166.1 Hirusutism.

Proceed as follows:

• Tell the examiner that you would like to:

• check the BP and urine for sugar
• look for signs of virilization (receding hairline, muscular development, breast atrophy, clitoromegaly).

• Comment on cushingoid features, if any.

Diagnosis

This patient has hirsutism (lesion) caused by polycystic ovarian disease (etiology) that is cosmetically unacceptable (functional status).

Questions

What do you understand by the term hirsutism?

Hirsutism is the male pattern of hair growth in women and consists of excessive terminal

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