Diagnostic Tests for Hairy elbows
Hairy elbows Tests: Book Excerpts
Hairy elbows Diagnosis: Book Excerpts
Diagnostic Tests for Hairy elbows: Online Medical Books
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HIRSUTISM:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The routine diagnostic workup includes a serum free testosterone, free cortisol, prolactin, a skull x-ray (much more economical than a CT scan or MRI of the brain), and a urinary gonadotrophin assay. If a pituitary tumor or lesion is strongly suspected, an FSH and LH should be done regardless of results of routine tests. An overnight dexamethasone test is more accurate than a routine free cortisol in diagnosing Cushing's syndrome. Pelvic ultrasound and CT scan of the abdomen would complete the workup, but why order these expensive diagnostic tests before consulting a gynecologist or endocrinologist?
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Hirsutism:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient where on her body she first noticed excessive hair. How old was she then? Where and how quickly did other hirsute areas develop? Does she use any hair removal technique? If so, how often does she use it, and when did she use it last? Next, obtain a menstrual history: the patient’s age at menarche, the duration of her periods, the usual amount of blood flow, and the number of days between periods.
Ask about medications, too. If the patient is taking a drug containing an androgen or progestin compound, or another drug that can cause hirsutism, find out its name, dosage, schedule, and therapeutic aim. Does she sometimes miss doses or take extra ones?
Next, examine the hirsute areas. Does excessive hair appear only on the upper lip or on other body parts as well? Is the hair fine and pigmented, or dense and coarse? Is the patient obese? Observe her for other signs of virilization.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hirsutism:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Hair growth. The exact distribution of terminal hair growth should be noted. A male type escutcheon (hair filling the superior pubic triangle) is a presumptive sign of hyperandrogenism. Some patients will have had unwanted hair removed, altering the clinical presentation.
B. Secondary sexual characteristics. Pathologic androgen excess is suggested by acne, oily skin, and signs of virilization (frontal balding, deepening of the voice, increase in muscle mass, and clitoromegaly). This is especially true if defeminization (loss of breast tissue, vaginal atrophy) is also present.
C. Other findings. A bimanual pelvic examination may reveal ovarian enlargement. Obesity with acanthosis nigricans (dark, velvety hyperpigmentation of the axilla, groin, neck, umbilicus) is suggestive of the insulin-resistant form of polycystic ovarian disease. Corticosteroid excess can produce the signs of Cushing’s syndrome.
Testing
Diagnostic testing is directed at confirming the cause of hirsutism suggested by the medical history and the physical examination (2).
A. Clinical laboratory tests. It is useful to measure the serum concentrations of testosterone and dehydroepiandrosterone sulfate (DHEAS) if an androgen-secreting neoplasm is suspected. If pituitary abnormalities, polycystic ovarian disease, or premature menopause are possibilities, then determine the serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin, as indicated by the clinical impression.
B. Diagnostic imaging. Ultrasonography can be used to detect ovarian cysts, but other imaging studies may be indicated if a neoplasm of the adrenals or ovaries is suspected.
Diagnostic assessment
The vast majority of patients with hirsutism will have either an idiopathic cause or polycystic ovarian disease. Studying other hirsute women can become a major diagnostic exercise that is best left to a physician with experience in these unusual cases. A patient can be considered to have idiopathic hirsutism if she has mild hirsutism that began shortly after the onset of puberty and progressed slowly, has regular menses, has an otherwise normal physical examination, does not have galactorrhea or virilization, and is not taking any medication associated with hirsutism. No further diagnostic assessment is needed for these women. Polycystic ovarian disease is seen in women between the ages of 15 and 25 years and is associated with a mildly elevated serum level of testosterone and DHEAS, a LH:FSH ratio of 2 or more, and cystic ovaries on ultrasonography. Among women with hirsutism, an adrenal tumor is unlikely if the serum levels of testosterone and DHEAS are normal (3). A dexamethasone suppression test is indicated for women with elevated values of testosterone or DHEAS to exclude a sinister cause of hirsutism. Treatment is cosmetic in women with idiopathic hirsutism, otherwise the underlying cause is targeted (4).
References
1. Toscano V. Hirsutism: pilosebaceous unit dysregulation. Role of peripheral and glandular factors. J Endocrinol Invest 1991;14:153–170.
2. Kalve E, Klein JF. Evaluation of women with hirsutism. Am Fam Physician 1996;54:
117–124.
3. Derksen J, Nagessar SK, Meinders AE, Haak HR, van de Velde CJH. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med 1994;331:968–973.
4. Knochenhauer ES, Azziz R. Advances in the diagnosis and treatment of the hirsute patients. Curr Opin Obstet Gynecol 1995;7:344–350.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Alopecia/Hirsutism:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Nonscarring alopecia includes androgenetic, telogen effluvium, trichotillomania, traction, aerata, and syphilis. Scarring alopecia is characterized by fibrosis, inflammation and loss of follicles, occurring with inflammatory dermatoses, deep infections, neoplasms, burns, and genodermatoses. Broken hair shafts are seen in fungal infections, traction, and trichotillomania.
Most hirsutism is familial. If a woman with hirsutism has normal menses, a family history of hirsutism, no virilization, and gradual onset, no further evaluation is needed.
Signs of androgen excess include defeminization with amenorrhea, decrease in breast size, or loss of female body contours more often than virilization. Other signs include acne, increased libido, clitoromegaly, temporal hair loss, deepened voice, and increased muscle mass. Acute onset of hirsutism and virilization suggests an androgen-producing adrenal or ovarian tumor, or exogenous androgen ingestion.
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Source: Field Guide to Bedside Diagnosis, 2007
Hirsutism:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the hirsute areas. Does excessive hair appear only on the upper lip or on other body parts as well? Is the hair fine but pigmented, or dense and coarse? Is the patient obese? Observe the patient for signs of virilization.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
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