Hirsutism history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Rasam Hajiannasab M.D.[3], Ahmed Younes M.B.B.CH [4]
Overview
The hallmark of hirsutism is excessive facial hair growth. A positive history of virilizing symptoms is suggestive of an underlying hormonal imbalance. The most important points in history taking regarding hirsutism in patients include: Age of onset, family history, and severity/progression.
History and Symptoms
History
- A good and accurate history of the onset and developmental milestones are important and useful in making a diagnosis of hirsutism.[1]
Age of Onset
- During puberty
- Mainly due to idiopathic hirsutism and other less serious causes of hirsutism
- Hirsutism in middle-aged or older women
- May suggest an adrenal or ovarian tumor
Family History
- Congenital adrenal hyperplasia (CAH) in a patient with a family history of hirsutism is consistent with the diagnosis. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) could also be familial and may be suggestive in making a diagnosis.
Hirsutism severity and rate of progression
- A benign form of hirsutism is usually characterized by pubertal onset with slow progression over many years. This is often true of hirsutism with PCOS.
- An androgen-secreting tumor is a possibility with a history of rapid severe hirsutism or other signs of virilization.
- Adrenarche and Puberty: Early development of pubic hair is a pointer towards CAH.
Common Symptoms
- Patients must be assessed regarding the presence or lack of virilizing signs such as:[2]
- Change in the voice or deepening voice
- Male pattern baldness
- Excess facial and body hair
- Clitoromegaly (enlargement of the clitoris)
- Increased muscle mass
- Acne
- Decreased breast size
- Amenorrhea
- Increased libido
- Signs of insulin resistance (eg, acanthosis nigricans, abdominal obesity)
Less Common Symptoms
References
- ↑ Ruutiainen K, Erkkola R, Grönroos MA, Irjala K (1988). "Influence of body mass index and age on the grade of hair growth in hirsute women of reproductive ages". Fertil. Steril. 50 (2): 260–5. PMID 3396696.
- ↑ Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.