Hirsutism

The etiology and significance of hirsutism depend on whether the patient is hirsute only (excessive hair), or if he/she is also virilized (increased weight, clitoromegaly, acne, deep voice). Polycystic ovarian syndrome (PCOS) is a very common cause; the incidence may be as high as 10–15% of women.

Differential Diagnosis

• 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)
  • Newborn screen for CAH

  Treatment

  • PCOS and idiopathic
    –Estrogen-predominant oral contraceptives decrease plasma androgens
    –Depo-Provera may also be used
    –Spironolactone works by competing for androgen receptors
    –Cimetidine has a side effect of decreasing testosterone and increasing estrogen levels
    –GnRH agonist to facilitate better function of the hypothalamic-pituitary axis
  • Drug-induced: Eliminate causative medication if possible and hirsutism may resolve spontaneously
  • Hyperprolactinemia: Bromocriptine (prolactin antagonist)

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Hair symptoms

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Hair symptoms

• Back to symptom: Hair symptoms: Introduction (review 645 causes)
• Next Book Extract About Hair symptoms: HIRSUTISM (Differential Diagnosis in Primary Care)
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More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: HIRSUTISM (Differential Diagnosis in Primary Care)

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