Diagnosis of Hypertrichosis
Hypertrichosis Diagnosis: Book Excerpts
Diagnostic Tests for Hypertrichosis: Online Medical Books
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HIRSUTISM:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there clitoral enlargement or other signs of virilism? These findings would suggest an ovarian tumor, an adrenal tumor or hyperplasia, chromosome mosaicism, and true hermaphroditism, which is rare.
- Is there obesity? The presence of obesity and hirsutism should bring to mind Cushing's syndrome. However, it is also a sign of polycystic ovaries.
- Is there a history of the use of the steroids or other drugs? Adrenocortical steroids, testosterone, phenytoin, minoxidil, and diazoxide are just a few of the drugs that may cause hirsutism.
- Is there an ovarian mass? The presence of an ovarian mass should make one think of polycystic ovaries, an arrhenoblastoma, or granulosis cell tumor. Remember, there may be no ovarian mass in polycystic ovary syndrome (Stein-Leventhal syndrome).
DIAGNOSTIC WORKUP
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?
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Hirsutism:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Drug-induced
–Cyclosporin, steroids, oral contraceptives, Dilantin, some diuretics (acetazolamide, hydrochlorothiazide), Minoxidil, penicillamines
-
Syndrome-associated
–Cornelia de Lange syndrome
–Trisomy 18
–Hurler syndrome
–Bloom syndrome
–Seckel syndrome
–Marshall-Smith syndrome
–Rubinstein-Taybi syndrome
–Leprechaunism
-
Ovarian
–PCOS
–Gonadal dysgenesis
–Ovarian tumors
-
Adrenal
–CAH
–Cushing syndrome
–17α-hydroxylase deficiency
–21-hydroxylase deficiency
–Adrenal tumor
-
Other causes
–Idiopathic
–5 α-reductase deficiency
–Hyperprolactinemia
–HAIR-AN syndrome (hirsutism,
androgenization, insulin resistance, and
acanthosis nigricans)
–Achard-Thiers syndrome: Obesity and facial hirsutism develop by 15–30 years of age; hypertension and obesity occur later
–Porphyria: Congenital erythropoietic porphyria have increased body hair, red urine, photosensitivity with bullae, and red to pink teeth (werewolves of old)
Workup and Diagnosis
- History
–Age of onset (PCOS presents in teen years, CAH can
present in infancy or adulthood)
–GU development and menstrual history
–Associated symptoms such as stress, weight changes,
acne, voice changes
–Medications
–Family history of hair growth patterns or endocrine
abnormalities
-
Physical exam
–Vital signs and complete exam of all systems to evaluate for signs of androgen excess
–Breast exam and detailed GU exam
–Abdominal exam to rule out pelvic or adrenal mass
-
Labs
–If virilization is present, check serum testosterone level, 17-hydroxyprogesterone and dehydroepiandrosterone
–If patient is not pregnant, progesterone challenge test may be performed; patient should have withdrawal bleeding after cessation of progesterone
–If no withdrawal bleeding occurs after challenge, check levels of estradiol, FSH, LH, and prolactin
–LH:FSH ratio >2.5:1 in PCOS (low relative FSH does not allow androstenedione to be converted to estradiol in the ovary, resulting in androgen buildup and anovulation)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
HIRSUTISM:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Clinically it is most important to look for obesity and virilism. A history of hypomenorrhea or amenorrhea is also important. The workup initially should include serum cortisol or 24-hour urine 17-hydroxycorticoids or 17-ketosteroids, and a thyroid profile. A skull x-ray and flat plate of the abdomen may be helpful. A cortisone suppression test may be required. An endocrinologist should be consulted before proceeding with CT scans of the brain, abdomen, and pelvis. A pituitary microadenoma may only be found by an MRI of the pituitary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Hirsutism:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A family history of hirsutism, absence of menstrual abnormalities or signs of masculinization, and a normal pelvic examination strongly suggest idiopathic hirsutism. Tests for secondary hirsutism depend on associated symptoms that suggest an underlying disorder. About 90% of women with hirsutism have an elevated free testosterone level.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hirsutism:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Onset. It is useful to determine the age of the onset of the hirsutism, its rate of progression, and the timing of any exacerbation of hair growth. The patient’s menstrual history, pregnancy history, or general medical history can yield important clues about an underlying endocrinopathy or another medical disorder.
B. Medications. A detailed medication history is important. Some medications cause hirsutism directly (e.g., androgenic oral contraceptives, anabolic steroids in body-builders) and can produce an increased libido. Others cause hirsutism indirectly by causing hyperprolactinemia (e.g., phenothiazines, tricyclic antidepressants), which can be associated with galactorrhea and menstrual abnormalities.
C. Family history. A familial pattern can be associated with idiopathic hirsutism, polycystic ovarian disease, and late-onset congenital adrenal hyperplasia.
Physical examination
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.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Alopecia/Hirsutism:
Differential Overview
(Field Guide to Bedside Diagnosis)
Alopecia
❑ Androgenetic
❑ Telogen effluvium
❑ Drugs/hair loss
❑ Anagen effluvium
❑ Alopecia areata
❑ Tinea capitis
❑ Traction
❑ Hypothyroidism
❑ Seborrheic dermatitis
❑ Discoid lupus
❑ Systemic lupus erythematosus
❑ Lichen planus
❑ Scleroderma
❑ Dietary deficiency
❑ Trichotillomania
❑ Syphilis
Hirsutism
❑ Idiopathic hirsutism
❑ Drugs/hair growth
❑ Hypertrichosis
❑ Hyperprolactinemia
❑ Polycystic ovary syndrome
❑ Cushing syndrome
❑ Adrenal tumor
❑ Ovarian tumor
❑ Ovarian hyperthecosis
Diagnostic Approach
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
Hirsutism:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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 menses, the usual amount of blood flow, and the number of days between menses.
Also ask about medications. 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?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
HIRSUTISM:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Clinically it is most important to look for obesity and virilism. A
history of hypomenorrhea or amenorrhea is also important. The workup
initially should include serum cortisol or 24-hour urine
17-hydroxycorticoids or 17-ketosteroids, and a thyroid profile. A skull
x-ray and flat plate of the abdomen may be helpful. A cortisone suppression
test may be required. An endocrinologist should be consulted before
proceeding with CT scans of the brain, abdomen, and pelvis. A pituitary
microadenoma may only be found by an MRI of the pituitary.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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