HIRSUTISM CAUSES AND TREATMENT

HIRSUTISM CAUSES AND TREATMENT

Definition
 

HIRSUTISM

  Is common and often unrecognized it mean excess hair growth  from androgen stimulation in female in abnormal sites like chine similar to men

Virilization

More severe form of hirsutism with accompanying clitoromegaly enlarged of clitores
male type pubic hair
temporal balding
 deepening voice

PHYSIOLOGY OF HIRSUTISM

 Androgens are derived from ovary and adrenal gland
 adrenal gland seceetes dehydroepiandrosterone DHA),dehydroepiandrosterone sulfate(DHAS) ,testosterone

 
 Ovary secretes androstenendione DHA,testosterone
 DHA,dehydroepiandrosterone and androstesneddione , converted peripherally to testosterone
 Androgens circulate bound to proteins including sex hormone  binding globulin (SHBG

DIFFERENTIAL DIAGNOSIS

 Hirsutism results from elevated level of free androgen
 may result from increased production exogenous administration decreased metabolism or decreased SHBG

 As in pregnancy which result in androgen excess.luteoma
solid ovarian enlargement .hyperreactio luteinalis :bilateral ovarian cysts both resolve after pregnancy

 Idiopathic hirsutism which elevated activity of 5 alpha -reductase which converts peripheral testosterone to the more active dihyrotestoterone

 Ovary as in polycystic ovary syndrome hyperthecosis :severe from of polycystic ovary syndrome with high levels of testosterone. ovarian tumors :sertoli - leydig tumors hilus cell tumors

 Adrenal as in congenital adrenal hyperplasia:deficiency of 21-hydroxylase 11beta-hydroxylase or 3 beta -hydroysreroid dehydrogenase most present during childhood late onset 21-hydroxylase deficieny may escape detection untill adulthood diagnosis by elevated 17-hydroxyprogesterone
 
Cushing,s syndrome :excess glucocorticoid production which diagnosis by dexamethasone suppression test physical findings as buffalo hump truncal obesity striae HTN adrenal tumor rare
 

 Miscellaneous as exogenous administration and abnormal gonad and sexual development

 

DIAGNOSTIC EVALUATION INCLUDE

 

 Physical examination as pattern and distribution of hair growth onset of symptoms as rapid onset increases likelihood of malignancy

 

Signs of virilization as clitoromegaly ,balding deepened voice and pelvic examination may reveals adnexal mass

 

WHAT ARE THE LABORATORY EVALUATION OF HIRSUTISM

 

  Testosterone if more than 200ng|dl need for pelvic ultrasound to rule out ovarian tumor if less than200ng|dl this mean decreased likelihood of neoplasm

 

 DHA if more than 700 ug|dl need MRI or CT to rule out adrenal neoplasm if from 500-700 ug|dl mean 17-OHP (17-HYDROXYPROGESTERONE )to rule out late onset CAH(congenital adrenal hyperplasia if less than 500 ug|dl mean empiric treatment

 

 17- OHP if more than 8ng|dl means late onset CAH if from 2.5-8 ng|dl means ACTH stimulation test to rule out late onset CAH

 

  ACTH(corticotropin stimulation test ) if 17-OHP increase more than 10 ng |dl means late onset CAH if less than 10 ng|dl late onset CAH ruled out

 

Low dose dexamethasone suppression test if cortisol more than  mg|dl means high dose dexamethasone suppression test required to diagnosis cushing,s syndrome if less than 5 ug|dl cushing,s syndrome ruled out

  

What are the treatment of hirsutism

 

  Oral contracptive pills considers drug of choice as progestins , depomedroxy-progeterone acetate or medroxyprogesterone

 

  Spironolactone from 100-200 mg qd which blocks androgen receptor suppresses production 

 glucocorticoids like dexamethasone .5 mg qd prednisone qb

 

 GnRH agonists but expensive like leuprolide )lupron)3.75 mg imq month

 

 

 Flutamide 250 mgqd androgen receptor antagonist Finasteride 5 mg qd  5 alpha - reductase inhibitor

Ketoconazole 400 mg qd inhibits androgen synthesis
 
 Cimetidine 300 mg qd

Eflornithine hydrochloride apply bid to facial which inhibits
   Lomithine decarboxylase FDA  approved only for facial hair side effects skin stinging

 Immediate hair removal :electrolysis depilatory cream 

tags:causes,hirsutism,treatment