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Hirsutism
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- Hirsutism is when male-patterned hair growth occurs in women. This includes hair growth on the face, chin, abdomen, and chest.
- Virilization is when frontal balding occurs, muscles increase in size, and the clitoris becomes enlarged and/or thickened.
- The cause of both Hirsutism and
virilization is excess androgens (male hormones). These
hormones are androstenedione, dehydroepiandrosterone
sulfate, and testosterone. Androstenedione is made in about
equal amounts by the ovaries and the adrenal glands.
Dehydroepiandrosterone sulfate (DHEAS) is secreted by the
adrenal glands. 60 % of the testosterone in the body is made
by the ovaries, while 40% is made when androstenedione in
the blood is converted to testosterone. Testosterone is the
active hormone (the other two act as precursors, but do not
have a direct effects by
themselves).
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- Hair growth on face (e.g., beard, mustache), chest, or abdomen
- Acne
- Menstrual irregularities
- Infertility (anovulation)
- Decreased breast size
- Frontal balding
- Increased muscle mass
- Deepening of the voice
- Enlargement of the clitoris
- High Blood Pressure
may be seen
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- Polycystic Ovary Syndrome
- Ovarian tumors
- Cushing's Syndrome
- Adrenal carcinoma
- Adrenal enzyme deficiencies
- 21- hydroxylase deficiency
- 11-hydroxylase deficiency
- Acromegaly
- Idiopathic (unknown)
- Familial (inherited)
- Brain lesions
- Ovarian luteoma of pregnancy
- Medications, e.g., Minoxidil, Dilantin, Danazol,
Cyclosporine, and some
progestins
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- If the serum testosterone is greater than 200 ng/dL, or free testosterone is greater than 40ng/dL, or the androstenedione is greater than 1000 ng/dL, pelvic exam and Ultrasound may be performed to look for ovarian cancer. If the Ultrasound is negative, a CT scan of the adrenal glands is performed to look for adrenal cancer.
- If the DHEAS is greater than 700 ug/dL, adrenal CT is checked (usually an overgrowth of the adrenal gland and not tumor).
- 17-Hydroxyprogesterone before and 30-60 minutes after Cosyntropin injection. If baseline is greater than 300 ng/dL, or after Cosyntropin, it is greater than1000 ng/dL, a diagnosis of congenital adrenal hyperplasia (21-hydroxylase deficiency) is made.
- Cushing's Syndrome -- Dexamethasone suppression test
- Serum levels of FSH and LH are elevated in ovarian failure. A ratio of LH:FSH is usually greater than 2.0 in polycystic ovarian disease
- Ultrasound will show
polycystic ovarian
disease
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- Treat the underlying cause if it exists (Acromegaly, Cushing's Syndrome, ovarian tumors, or adrenal tumors). See those sections for more information. Discontinue any offending medications.
- 21-hydroxylase deficiency, options include:
- Birth control pills
- Spironolactone
- Dexamethasone
- Ketoconazole
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