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Practice Algorithm
Hirsutism
Dan Israel Lebovic, MD, MA
Hirsutism affects up to 8% of women.1 It is defined as the presence
of excessive terminal hair growth from androgen-dependent pilosebaceous
units in regions of a woman’s body not usually associated with
such hair growth. Hirsutism is a by-product of increased androgen action
on hair follicles or increased sensitivity of hair follicles to normal
levels of androgens. Although most etiologies are not life-threatening,
hirsutism infrequently may herald more serious pathologies such as an
androgen-producing neoplasm.
The possible causes of excess androgen production are myriad, including familial, idiopathic, ovarian (eg, tumors, polycystic ovary syndrome), and adrenal (eg, tumors, nonclassic congenital adrenal hyperplasia). Exogenous pharmacologic sources must be considered as well.
A thorough history and physical examination should evaluate amounts, characteristics, and distribution of hair growth; virilization (eg, deepening of the voice, pronounced acne) should also be noted. A pelvic examination—physical and/or via transvaginal ultrasonography—should be performed to exclude any masses. Limited laboratory testing may be required to rule out potentially serious underlying conditions (Figure).2,3
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FIGURE.
Evaluation of female sexual dysfunction.
dexa suppr = dexamethasone suppression; P4 = progesterone;
17 OHP = 17α hydroxyprogesterone; PCOS = polycystic ovary syndrome;
NCAH = nonclassic congenital adrenal hyperplasia; ACTH = adrenocorticotropic
hormone; TSH = thyroid-stimulating hormone; PRL = prolactin. |
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Dan Israel Lebovic, MD, MA, is associate professor and co-director, University of Michigan Endometriosis Center, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan Hospitals, Ann Arbor.
References
- Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders of 950 women referred because of clinical hyperandrogenism. J
Clin Endocrinol Metab. 2006;91(1):2-6.
- Hunter MH, Carek PJ. Evaluation and treatment of women with hirsutism. Am
Fam Physician. 2003;67(12):2565-2572.
- Rosenfield RL. Clinical practice. Hirsutism. N
Engl J Med. 2005:353(24):2578-2588.
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