Hirsutism

Hirsutism is a problem due to excessive growth of androgen dependent hair , usually grow on mid line areas , upper lip , chin , ears , checks , lower abdomen , back and proximal limbs.

Hirsutism is a biological sign of androgen over production , but in some cases it is due to hypersensitivity of the hair follicles towards secreted androgen , If it due to androgen overproduction , it is usually accompanied with oily skin , acne , menstrual disorders , infertility and finally defeminization.

N.B. : Virilization , It is the result of extreme androgen production and it is characterized by temporal balding and voice deepening.

Hirsutism causes

There are multiple causes results in hirsutism , like ovarian causes , adrenal causes and as a result of cushing syndrome and also there may be no causes and in that case it called idiopathic hirsutism , all those causes results in hirsutism by increasing androgen production or increase hair follicle sensitivity to circulating androgen .

Ovarian causes

In cases of polycystic ovarian disease , as there are accumulation of androstendione due to its deficient conversion to estradiol  . It also seen in patients has androgen producing ovarian tumors , such as adrenal rest tumors and gynoandroblastoma.

Adrenal causes

It is seen in patients have adult onset congential adrenal hyperplasia , in these patients there is lack of 21 hydroxylase or 11 hydroxylase enzymes. It also seen in patients with androgen secreting adrenal tumors .

Other causes

Hirsutism may be aresult of cushing syndrome , in which the patient is characterized by having hypertension , diabetus also truncal obesity , also it may results from androgenic therapy as in cases of endometriosis , and Danazol therapy .

Idiopathic hirsutism

It is mainly due to increase hair follicle receptors sensitivity to the secreted androgen.

Hirsutism treatment

Treatment of hirsutism started by taking detailed history include family history , history of drug prescription , also reviewing symptoms of ovarian tumors and taking detailed history of menstrual history is so important , after history any female should examined for seeing hair distribution and also see cushing syndrome manifestation , and finally assessing for presence of any masses ( ovarian tumors ) , after both history and examination , female patient should estimate her free testosterone ( normal level : 2-12 pg/ml) , also total testosterone ( normal level : 0.2-0.8 ng/ml) , as more than 2 ng is highly suggestive of androgen secreting tumors. In  cases of cushing syndrome it is advised to do dexamethasone supression , searching hirsutism causes abdominal and plevic U/S is advised.

Treatment options for hirsutism

Treatment of the cause as treating Poly cystic ovarian syndrome and androgen secreting tumors .

Medication for Hirsutism

1. Cyproterone : anti-androgen with progesterone effect , which compete with androgen at the receptors , 100 mg/day oral , it is advised to be accompanied with ethinyl estradiol to prevent menstraul disturbance .

2. spironolactone : 10 mg/day as that drug compete with androgen hormone at it’s site.

3. progesterone and oral contraceptive pills with progesterone content .

Cosmetic methods for hisutism : as hair removal by shaving which is an old method and nowadays there are arise to laser removal and electrolysis .

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