Hirsutism physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
One method of evaluating hirsutism is the Ferriman-Gallwey score which gives a score based on the amount and location of hair growth on a woman.
Physical Examination
The first part of physical examination is to quantitate the hirsutism . The common method to quantitate hirsutism is using Ferriman and Gallwey.
- The grade for each area ranges from 0 (no terminal hair) to 4 (frankly virile).
- The body areas used to grade hirsutism are (1) the upper lip, (2) chin, (3) chest, (4) leg, (5) thigh, (6) upper arm, (7) forearm, (8) upper back, (9) lower back, (10), upper abdomen, and (11) lower abdomen.
- Areas such as the axilla and pubis are not included because terminal hair grows in these places at normal androgen levels in women.
- A woman with a score of 8 or higher is considered to have hirsutism. Most women who seek medical attention for the disorder have scores of 15 or higher. Normal scores have also been established for Turkey (up to 11) and Thailand (up to 3 on the modified Ferriman and Gallwey scale).
- In women with moderate-to-severe hirsutism (score >15), seek additional signs of hyperandrogenism, including (1) temporal hair recession, (2) oily skin, (3) masculine voice, (4) well-developed musculature, (5) enlargement of the clitoris (>35 mm 2 in surface area), (6) irregular menses, and (7) psychological changes (eg, heightened libido, aggressiveness).
- The degree to which these clinical factors are present suggests the level of androgen overproduction and, thus, helps to determine the degree of concern for the presence of an underlying disease.
- The extent of the evaluation for the cause of hirsutism is greater in women who have more severe clinical evidence of masculinization.
- A thorough abdominal and pelvic examination is important in patients with hirsutism because more than half of androgen-secreting adrenal and ovarian tumors are palpable.
- Examine the skin for acanthosis nigricans, a manifestation of insulin resistance.
- Women with hirsutism are usually obese, with increased waist-hip ratios, and are thought to be at an increased risk for atherosclerosis and coronary heart disease. They also have increased bone mineral density scores at the hip and spine. These increases correlate with higher levels of serum free testosterone and estrogen
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| Upper lip | 0-4 |
|---|---|
| Chin | 0-4 |
| Leg | 0-4 |
| Thigh | 0-4 |
| Upper arm | 0-4 |
| Forearm | 0-4 |
| Upper back | 0-4 |
| Lower back | 0-4 |
| Lower abdomen | 0-4 |