موقع نقابة الأطباء فرع دمشق - الشعرانية-د.سونيا اسطفان

Dr.Sonia Astafan,M.D.,MSc

Definition

Hirsutism

Hypertrichosis

Physiologic mechanism of andg. Activity:

-production of andg. (adrenals , ovaries)

andg. transport in blood on carrier pro.(SHBG)

intercellalar modification & binding to andg. receptors

Pathophysiology

Free T(SHBG)>dihydrotestosterone (blood,skin)

Deceased SHBG> increase in free T

Increased estrogen> decreased SHBG (OC)

Increased SHBG >lower activity of circulating T

In response to: SHBG decrease

-exogeous andg.

-certain dis.(PCO)

-CAH , delayed-onset AH

-cushing syn.

-obesity

-hyperinsulinemia , hyperprolactinemia

-excess growth h.

-hypothyroidism

Frequency
5-10% USA , International
Race:fair skin f.,genetic (5-alpha-reductase),CAH

Sex: men, women

Age:

Mortality & Morbidity: underlying cause

History

Age of onset

Family history

Hirsutism severity &rate of progression

Adrenarche & puberty

Physical

Signs & symptoms:

Acanthosis nigricans

Obesity

Pelvic mass

Signs &symptoms of virility

Signs &symptoms of cuching syn.

Acne

alopecia

Ferriman–Gallwey

0-4

Body areas : upper lip, chin , chest , leg , thigh , upperarm , forearm , upper back , lower back , upper abdomen , lower abdomen.
Normal: Turkey(up to 11) , thailand (up to 3)

hirsutism >8

Moderate to severe hirsutism>15

Causes

Causes

Ovarian:50% PCO

Luteoma of pregnancy

Arrhenoblastoma

Leydig cell tumors

Hilar cell tumors

Thecal cell tumors

Causes

Adrenal

CAH:21- hydroxylase deficiency

3-hydroxysteroid dehydrogenase deficiency

11- hydroxylase deficiency

Cuching syn.

Adrenal tumors

Causes

familial hirsutism(mediterrean , middle east)

- drug- induced hirsutism:(DHEA-S) , T , danazol , OC , anabolic steroids , phenytoin , minoxidil , diazoxide , cyclosporine , streptomycin , psoralen , penicillamine , phenothiazines , acetazolamide , hexachlorbenzene. . . .

Other Causes

Anorexia nervosa , acromegaly , hypothyroidism , hyperprolactinemia , porphyria , idiopathic hirsutism , trisomy18 , hurler syn. &other mucopolysaccharidoses , hair growth in sites of trauma and scarring. . . . .

Lab Studies

Serum T:total , free

Serum DHEA – S

Dexamethasone suppression

ACTH suppression

Cortisol suppression

Serum androstenedione , LH , FSH

17- hydroxyprogesterone

Urinary cortisol test

Serum prolactin

Diabetes screening

Prostate–specific antigen