Hirsutism is an affliction that affects about 8% of women.
It is often due teffects that are not life-threatening, such as chronic anovulation.
Hirzutimat is defined as the presence of excessive hair in androgen dependent skin areas of the female body (banenbardi and skin stretches over the upper and lower lip).
The disease is a sign of increased androgen action on the terminal part of the hair follicles or increased sensitivity of hair follicles tnormal levels of androgens.
Often Hirsutism may signal the presence of serious pathology masculinization tumors or other conditions requiring specific therapies.
In 60-80% of women with hirsutism establishes elevated levels of circulating androgens.
Hyperhidrosis is defined as a diffuse increase in the overall hairy hair and is not androgen-driven process. Hyperhidrosis can be congenital (Harlar syndrome, trisomy 18th or fetal alcohol syndrome) or associated with hypothyroidism, porphyria, epidermolysis bullosa, anereksiya neurosis, malnutrition or dermatomioliza. It can alsbe observed after head trauma, or be drug induced (cyclosporine, diazoxide, hydrocortisone, minoxidil, psoralens, streptomycin).
When examining a patient with hirsutism have tremember that it is only one of the signs of hiperandrogenizma.
The most common abnormalities associated with elevated levels of androgens are: (1) Acne vulgaris; (2) alopecia; (3) android obesity; (4) cardiovascular diseases; (5) dyslipidemia; (6) impaired glucose tolerance; (7) hypertension; (8) The menstrual dysfunction.
Hirsutism may be:
- Due tincreased androgen secretion by the ovaries (tumors, polycystic ovary syndrome)
- Due tincreased androgen secretion by the adrenal glands (congenital adrenal hyperplasia, Cushing’s syndrome or tumor)
- Exogenous pharmacologic source: cyclosporine, androgens, metoclopramide, reserpine, progestins, methyldopa
The table below sumarizirani some of the etiological causes and their diagnostics.
|Causes of hirsutism, associated laboratory findings and additional tests|
History and physical examination are important testablish the nature of hirsutism. About 50% of patients had a positive family history of this suffering.
Key elements of history are sumarizirani below:
- abdominal symptoms
- family history
- Data on breast development in puberty
- Menstrual, reproductive and medical history
- Skin changes (stretch marks, acne)
- Symptoms of virilization
We should be aware of the methods by which patients are struggling with hirsutism.
Discussion on the physiological and social aspects of hirsutism should alsbe held.
Physical examination gives the differential diagnosis between hirsutism and hypertrichosis. It should be alscarried out abdominal and gynecological manual review.
The key elements of the physical examination are sumarizirani below:
- Body weight, height and blood pressure
- Investigation of hair feature
- Establishment of skin changes (acne, stretch marks)
- Palpation for abdominal and pelvic tumor masses
- Establishing physical signs of Cushing’s syndrome (acne, stretch marks, proximal muscle weakness, bull neck, face like the moon and central obesity)
- Signs of virilization
Identification of serious underlying disease is detected by laboratory tests and additional tests.
About 95% of patients with hirsutism have polycystic ovary syndrome or idiopathic hirsutism.
Patients with prepuberteten hirsutism, slow development of hirsutism, normal physical examination and nvirilization neoplasm probability is extremely small.
For diagnostic screening testosterone levels and 17a hydroxyprogesterone usually suffice.
At levels of serum testosterone above 200 ng of / dl and free testosterone levels above 40 ng of / dl is performed ultrasound of the genital system, if it does not show pathology is performed CT adrenal.
In serum androstenedione over 1000 ng / dl should be suspected adrenal or ovarian neoplasm.
Levels of dehydroepiandrosterone ( DHEAS ) 700 scales / dl speak in favor of adrenal androgen source, usually adrenal hyperplasia or neoplasia, and must be performed CT adrenal.
Follicle stimulating and luteinizing hormones are usually elevated in the case of ovarian failure.
The rati”LH / follicle stimulating hormone” more than 2 amid hyperglycemia was observed in polycystic ovary syndrome.
In patients with a vague hyperandrogenism should be screened for developing late-21 hydroxylase deficiency where baseline levels of 17-hydroxyprogesterone are typically greater than 300 ng / dl or stimulated levels over 1000 ng / dl (30-60 minutes after 0.25mg IM cosyntropin ).
At the simple algorithm for the Study of hirsutism is as follows
Signs of Cushing’s syndrome
D> should test for Cushing
Изследват се нивата на right
- High> 700Ranges / dl, should suppressive test and depending on
- There suppression>adrenal hyperplasia
- Няма супресия>Адренална неоплазия
- Low<700ranges / dl, follows a study of serum testosterone
- Levels t2 times above the norm should studythe LH/ the FSH ratio
- <2 (Хипоталамусна дисфункция№
- > 2 (polycystic ovary syndrome)
- Levels above 2 times above the norm should pelvic CT or MRI of the pelvis (usually established ovarian neoplasm)
Suppression test of DHEAS is as follows: take 0.5 mg of dexamethasone every 6 hours for 5 days, and the levels of dihidroepiandrosterona must fall below 170 Ranges / dl , and the test is considered positive.