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Hirsutism

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  1. See Also
    1. Hyperandrogenism
    2. Hypertrichosis
  2. Definition
    1. Increased sexual Hair Growth
    2. Women develop male-type body hair distribution
      1. Face
        1. Mustache
        2. Beard
        3. Sideburns
      2. Body
        1. Chest
        2. Circum-areolar
        3. Linea alba
        4. Abdominal trigone
        5. Inner Thighs
  3. Physiology
    1. See Hair Growth
  4. Epidemiology
    1. Excessive upper lip hair in a third of women ages 14-45
    2. Unwanted chin and sideburn hair in 6-9% of women
  5. Causes
    1. See Hyperandrogenism Causes
    2. Idiopathic hirsutism (5-15% of cases)
  6. Labs: General
    1. Serum Prolactin
    2. Thyroid Stimulating Hormone (TSH)
    3. Consider Endometrial Biopsy
  7. Labs: Adrenal hyperplasia or tumor evaluation
    1. Indications
      1. Onset after Puberty
      2. Rapid progression
      3. Irregular Menses
      4. Exam suggesting Hyperandrogenism or virilization
      5. Family History does not suggest familial cause
    2. Tests
      1. Dehydroepiandrosterone Sulfate (DHEAS) >700 ug/dl
      2. Serum Testosterone exceeds 200 ng/dl
        1. Evaluate for ovarian or Adrenal Mass
      3. 17-alpha hydroxyprogesterone >200 ng/dl
        1. Evaluate with ACTH stimulation test
  8. Management: Hair Removal
    1. See Hair Removal Techniques
  9. Management: Anti-androgen management
    1. Hirsutism related to excess androgen from Anovulation
    2. Management directed at reducing DHT and androgens
      1. Inhibit ovary and adrenal androgen secretion
      2. Alter Sex Hormone Binding Globulin (SHBG) binding
      3. Impair peripheral androgen precursor conversion
      4. Inhibit androgen action at target tissue
    3. General Measures
      1. Weight loss if Obesity present (lowers androgens)
      2. See Hair Removal Techniques
    4. Medications: First line
      1. Oral Contraceptives
        1. Lowers Serum LH: Decreases Testosterone production
        2. Increase Serum SHBG: Increases Testosterone binding
        3. Decreases Free Testosterone (unbound) levels
        4. Lowest Progestin Androgenic Activity
          1. Norgestimate (Ortho Tricyclen, Ortho Cyclen)
          2. Desogestrel (Ortho-Cept, Desogen)
          3. Norethindrone (Modicon)
          4. Ethynodiol (Demulen 1/35)
      2. Spironolactone 50 to 200 mg PO divided bid to tid
      3. Eflornithine (Vaniqa) 13.9% cream
    5. Medications: Second-Line for specific indications
      1. Metformin (Glucophage): Polycystic Ovary Syndrome
    6. Medications: Third line due to potential toxicity
      1. Antiandrogen
        1. Flutamide (Eulexin) 250 mg bid to tid
        2. Finasteride 5 mg qd
      2. Glucocorticoid: Dexamethasone 0.5 mg PO qHS
      3. GnRH agonist: Leuprolide (Lupron Depot)
        1. Dose: 3.75 mg IM qMonth for 6 months
        2. Depot dose: 11.25 mg q3 months
  10. References
    1. Hansen (1997) Female Patient 22:11-18
    2. Gilchrist (1995) Am Fam Physician 52(6):1837
    3. Hunter (2003) Am Fam Physician 67:2565
    4. Kalve (1996) Am Fam Physician 54(1):117
    5. Leung (1993) Int J Dermatol 32:773
    6. Shenenberger (2002) Am Fam Physician 66(10):1907

Hirsutism (C0019572)

Definition (MSH)A condition observed in WOMEN and CHILDREN when there is excess coarse body hair of an adult male distribution pattern, such as facial and chest areas. It is the result of elevated ANDROGENS from the OVARIES, the ADRENAL GLANDS, or exogenous sources. The concept does not include HYPERTRICHOSIS, which is an androgen-independent excessive hair growth.
Definition (CSP)excess hair in females and children with an adult male pattern of distribution.
ConceptsFinding (T033)
ICD9704.1
MSHD006628
EnglishHAIRINESS, Hirsutes, Hirsuties, Hirsutism, Pilosis
Spanishcrecimiento excesivo del pelo, hirsutismo, pilosis
Parent ConceptsHair and hair follicle diseases (C0554472), Signs and Symptoms (C0037088), Hair Diseases (C0018500), ADRENAL DYSFUNCTION (C0549609), Virilism (C0042755), Reproductive System Finding (C1335757), Disorder of hair growth (C0554471), Ambiguous concept (C1274012)
SourcesAOD, COSTAR, CSP, CST, DXP, ICD9CM, MSH, MTH, NCI, NDFRT, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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