Diagnostic Tests for Hirsutism
Hirsutism Tests: Book Excerpts
Hirsutism Diagnosis: Book Excerpts
Diagnostic Tests for Hirsutism: 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
Weight gain, excessive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?
Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Weight loss, excessive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin with a thorough diet history because weight loss almost always is caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask him about previous weight and if the recent loss was intentional. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. For example, has he gotten separated or divorced? Has a family member or friend died recently? Has he recently changed jobs?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially any use of diet pills and laxatives.
Carefully check the patient’s height and weight, and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
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
Alopecia [Hair loss]:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t receiving a chemotherapeutic drug or radiation therapy, begin by asking when he first noticed the hair loss or thinning. Does it affect the scalp alone, or does it occur elsewhere on the body? Is it accompanied by itching or rashes? Then carefully explore other signs and symptoms to help distinguish between normal and pathologic hair loss. Ask about recent weight change, anorexia, nausea, vomiting, excessive stress, and altered bowel habits. Also ask about urinary tract changes, such as hematuria or oliguria. Has the patient been especially tired or irritable? Does he have a cough or difficulty breathing? Ask about joint pain or stiffness and about heat or cold intolerance. Inquire about exposure to insecticides. If the patient is female, ask if she has had menstrual irregularities and note her pregnancy history. If the patient is male, ask about sexual dysfunction, such as decreased libido or impotence.
Next, ask about hair care. Does the patient frequently use a hot blow dryer or electric curlers? Does he periodically dye, bleach, or perm his hair? If the patient is black, ask if he uses a hot comb to straighten his hair or a long-toothed comb to achieve an Afro look. Does he ever braid the hair in cornrows? Check for a family history of alopecia, and ask what age relatives were when they started experiencing hair loss. Also ask about nervous habits, such as pulling the hair or twirling it around a finger.
Begin the physical examination by taking vital signs and then assessing the extent and pattern of scalp hair loss. Is it patchy or symmetrical? Is the hair surrounding a bald area brittle or lusterless? Is it a different color than other scalp hair? Does it fall out easily? Inspect the underlying skin for follicular openings, erythema, loss of pigment, scaling, induration, broken hair shafts, and hair regrowth.
Then examine the rest of the skin. Note the size, color, texture, and location of any lesions. Check for jaundice, edema, hyperpigmentation, pallor, or duskiness. Examine nails for vertical or horizontal pitting, thickening, brittleness, or whitening. As you do so, watch for fine tremors in the hands. Observe the patient for muscle weakness and ptosis. Palpate for lymphadenopathy, enlarged thyroid or salivary glands, and masses in the abdomen or chest.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Weight gain, excessive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine your patient’s previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Next, ask about associated symptoms. Has he experienced visual disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation?
Form an impression of the patient’s mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he using?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status.) Note fat distribution, the presence of localized or generalized edema, and overall nutritional status. Examine the patient for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Weight loss, excessive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask about his previous weight and whether the recent loss was intentional. Be alert for lifestyle or occupational changes that may be causing anxiety or depression. For example, has he gotten separated or divorced? Has he recently changed jobs?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially the use of diet pills or laxatives.
Carefully check the patient’s height and weight, and ask about exact weight changes with approximate dates. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident?
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also, check the patient’s eyes for exophthalmos and his neck for swelling; auscultate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic tests, such as complete blood count, serum albumin levels, urinalysis, chest
X-rays, and upper GI series, usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
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.
» READ BOOK EXCERPT ONLINE »
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.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Patterned Erythema:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Sun-exposed areas of the face, the “V” of the neck (but not under the chin), and the dorsum of the hands and feet are common distributions for photodermatitis.
» READ BOOK EXCERPT ONLINE »
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
Weight gain, excessive:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
During your physical assessment, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 710 and 711.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Weight loss, excessive:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Carefully check the patient’s height and weight. Ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations, such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause of weight loss.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hair Loss:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Diagnosisof hair loss in children can often be made by history and physicalexam.About 90–95% of casesinvolve acquired localized hair loss with tinea capitis, traction alopecia,trichotillomania, or alopecia areata.Diagnosis of tinea capitis is usuallyclinical, but if diagnosis is uncertain, KOH preparation can beperformed. If results are negative, fungal culture should be performed.Most diffuse hair loss is acquired,and most common causes are anagen effluvium (usually chemotherapeuticagents) and telogen effluvium. History and microscopic exam of hairis usually diagnostic of anagen or telogen effluvium.Hair shaft defects also can cause diffusehair loss, but they are rare. Diagnosis is made by microscopic examof hair.Skin biopsy is often necessary in diagnosisof unusual lesions (e.g., aplasia cutis congenita, lichen planus,discoid lupus erythematosus, and morphea).
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Weight gain, excessive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Determine your patient's previous patterns of weight gain and loss. Does he have a family history of obesity, thyroid disease, or diabetes mellitus? Assess his eating and activity patterns. Has his appetite increased? Does he exercise regularly or at all? Ask about associated symptoms. Has the patient experienced vision disturbances, hoarseness, paresthesia, or increased urination and thirst? Has he become impotent? If the patient is female, has she had menstrual irregularities or experienced weight gain during menstruation? Is she menopausal or postmenopausal?
Form an impression of the patient's mental status. Is he anxious or depressed? Does he respond slowly? Is his memory poor? What medications is he taking?
During your physical examination, measure skin-fold thickness to estimate fat reserves. (See Evaluating nutritional status, pages 644 and 645.) Note fat distribution and the presence of localized or generalized edema and overall nutritional status. Inspect for other abnormalities, such as abnormal body hair distribution or hair loss and dry skin. Take and record the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Weight loss, excessive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin with a thorough diet history because weight loss is almost always caused by inadequate caloric intake. If the patient hasn't been eating properly, try to determine why. Ask him about previous weight and whether the recent loss was intentional. Determine how long the weight loss has been taking place. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. Has the patient recently experienced a loss?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Has he been experiencing other pain? If so, ask about the location of the pain and how long he has had it. Take a careful drug history, noting especially use of diet pills and laxatives.
Carefully check the patient's height and weight and ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Examine the patient's skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth and note hyperpigmentation of the buccal mucosa. Check the patient's eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause. Almost all physical causes are clinically evident during the initial evaluation. Cancer, GI disorders, and depression are the most common pathologic causes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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