Hirsutism

Binarwan Halim
Outline
• Introduction
• Definition
• Causes
• Clinical evaluation
• Investigations
• Treatment
• Conclusion
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Introduction

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Incidence
Cycle growth of hair
Type of hair
Sites of hair
Androgen in the blood
Androgen at target cell
(hair follicle)
Definition

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 HIRSUTISM

APPEARANCE OF EXCESSIVE COARSE

(TERMINAL)HAIR IN A PATTERN NOT
NORMAL IN THE FEMALE
• Definition highlights the abnormal distribution of
excess hair growth ,such as facial ,chest,or upper
abdominal hair
 HYPERTRICHOSIS

GROWTH OF HAIR IN EXCESS OF THE

NORMAL WHILE LIMITED TO A NORMAL
PATTERN OF DISTRIBUTION
• It is frequently associated with the use of
medication such as antiepileptics
 VIRILIZATION
REFERS TO CONCURRENT PRESENTATION OF
HIRSUTISM WITH A BROAD RANGE OF SIGNS
SUGGESTIVE OF ANDROGEN EXCESS,SUCH AS
• ACNE,
• FRONTOTEMPORAL BALDING,
• DEPPENING OF THE VOICE ,
• A DECREASE IN BREAT SIZE
• CLITORAL HYPERTROPHY
 Hirsutism:
• Not an increase in the number of hair follicles
but an alteration in their character.
• An increase in the transformation of the vellus
to terminal hair.
• {Androgens will convert lanugo & vellus hair
to terminal hair}
 Normal Androgen Synthesis

Pituitary
(+)
A CT
H Cortex:
G  aldosterone

Adrenals

(+)
F
R  Cortisol
Androgens
LH

Ovaries
Theca Cells  Androstenedione & Testosterone
(+)
F SH
Granulosa Cells
Estrone & Estradiol
 Asetat

Kolesterol
Sitokrom P450 scc

Pregnanolon Progesteron
17 α OH ase 17 α OH ase

17 OH Pregnanolon 17 OH Progesteron E3

3 β OH SDH
17-20 Desmolase 17-20 Desmolase ?
ATAZ
OM
AR
DHEA Androstenedion E1
17 β OH SDH 17 β OH SDH 17 β OH SDH
Z
M ATA
Androstenediol Testosteron AR O
E2
5 α redüktase

DHT
 Adrenal Korteks

%25 %50 %50 %100

T %50 Androstenedion DHEA %30 DHEAS

%25 %50 %20

Over
Causes

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 B. Adrenal

• •Cong adrenal hyperplasia

•Tumors
•Cushing syndrome
 C. PERIPHERAL

C. PERIPHERAL
•Idiopathic: Regular ovulation & normal
androgen levels
•Insulin resistance
– HAIRAN syndrome: HyperAndrogenic
Insulin-Resistant Acanthosis Nigricans
– 5H syndrome
acanthosis nigricans
 D. Drugs

Hunter, 2003
Clinical evaluation

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 Primary objective:

Confirm diagnosis
Determine degree
Exclude life threatening diseases
History
 Examination

General:
Thyroid disease,
Cushing syndrome,
Signs of virilization,
Signs of insulin resistance e.g. acanthosis
nigricans
Investigations

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 Ovarian tumors should be
suspected
1. Rapid onset of virilization
2. Unilateral adenxal mass
3. Testosterone >200 ng/dl.
•TVS, CT or MRI.
 Screening for Cushing
syndrome
•Rare
•Indications:
Centripetal obesity, buffalo hump
Moon face, Virilization
Pigmented stria, Hypertension
Treatment

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I. General
II. Specific
III. Local
IV. Surgery
V. Insulin sensitizer: Metformin
TERIMA KASIH