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==Stroke in Alphabetical Order==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
*[[Adenosine deaminase deficiency]]
|-
*[[Air embolism]]
| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Diagnosis'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Incidence'''||style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center |'''Onset'''||style="padding: 0 9px; font-size: 100%; background: #F5F5F5;" align=center | '''Common symptom'''
*[[familial dysfibrinogenemia|Ales dysfibrinogenemia]]
|-
*[[amphetamine|Amphetamine abuse]]
| style="font-size: 90%; padding: 0 10px; background: #DCDCDC" align=left |❑ [[Polycystic ovary syndrome]] <br>
*[[Amyloid angiopathy]]
 
*[[Amyloidosis]]
❑ [[hirsutism|Idiopathic hirsutism]]<br>
*[[Aneurysm ]]
 
*[[angioma|Angioma hereditary neurocutaneous]]
❑ [[Congenital adrenal hyperplasia]] <br>
*[[Antiphospholipid syndrome]]
 
*[[Antithrombin III deficiency]]
❑ Ovarian and androgen secreting tumors <br>
*[[Arteriosclerosis obliterans]]
 
*[[Arteritis]]
❑ Drug induced <br>
*[[Atheroma]]
 
*[[Atherosclerosis]]  
❑ [[HAIR-AN Syndrome]] <br>
*[[Atrial fibrillation]]
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ 70-85%<br><br> ❑ 5-15%<br><br> ❑ 1-8%<br><br>
*[[Atrial myxoma]]
❑ 0.3-0.1%<br>
*Atrial septal aneurysm
 
*[[Atrial septal defect]]
 
*[[Autonomic dysreflexia]]
❑ 0.5-1% <br>
*[[Autosomal dominant polycystic kidney disease]]
 
*[[Bacterial endocarditis ]]
 
*[[Behcet's disease]]
❑ 3-4%
*[[Bing-Neel syndrome]]
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ PCOS insidious<br>  
*[[Binswanger's disease]]
 
*[[Bioprosthetic valves]]
❑ Idiopathic hirsutism Insidious<br>
*[[Bleeding disorders]]
❑ CAH rapid <br><br>
*[[CADASIL]]<ref name="pmid8878478">{{cite journal| author=Joutel A, Corpechot C, Ducros A, Vahedi K, Chabriat H, Mouton P et al.| title=Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. | journal=Nature | year= 1996 | volume= 383 | issue= 6602 | pages= 707-10 | pmid=8878478 | doi=10.1038/383707a0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8878478  }} </ref>
❑ Tumors rapid <br>
*CARASIL<ref name="pmid21215656">{{cite journal| author=Fukutake T| title=Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification. | journal=J Stroke Cerebrovasc Dis | year= 2011 | volume= 20 | issue= 2 | pages= 85-93 | pmid=21215656 | doi=10.1016/j.jstrokecerebrovasdis.2010.11.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21215656 }} </ref>
 
*[[Cardiac arrest]]
 
*[[Carotid artery dissection]]
 
*[[Carotid artery stenosis]]
 
*[[Carotid artery stenosis]] 
 
*[[Cerebral hemorrhage]]
❑ HAIRAN syndrome insidious
*[[adult brain tumors|Cerebral ventricle neoplasm]]
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |
*[[cocaine|Cocaine overdose]]
❑ Irregular menses, hyperandrogenism, polycystic ovary <br>
*[[Congenital heart disease]]
❑ No other known cause, normal ovaries, normal anbdrogens <br>
*[[Congestive heart failure]]
 
*[[adenoma|Conn's adenoma]]
 
*[[Conn's syndrome]]
 
*[[adrenocortical carcinoma|Conn-Louis carcinoma]]
❑ Total testosterone > 200ng and does not respond to treatment <br>
*[[Conversion disorder]]
 
*[[Coronary angiography]]
❑ Related to medications (steroids, danazol etc) <br>
*[[coronary artery bypass surgery|Coronary artery bypass graft (CABG) surgery]]
 
*[[Crack addiction ]]
❑ Subset of PCOS with insulin resistance and acanthosis nigricans
*[[Crystal meth addiction]]
|}
*[[Cystathionine beta-synthase deficiency]]
 
*[[Decompression sickness]]
 
*[[diabetes mellitus|Diabetes mellitus type I]]
 
*[[Diabetes mellitus type II]]
 
*[[Dilated cardiomyopathy]]
 
*[[Dissecting aortic aneurysm]]
 
*[[Dissection]]
 
*[[Dysbarism]]
 
*[[Eclampsia]]
 
*[[Ecstasy overdose]]
 
*[[Embolism]]
 
*[[Endocarditis]]
 
*[[Endomyocardial fibrosis]]
 
*[[Essential thrombocytosis]]
 
*[[Fabry's disease]]
 
*[[Factor V Leiden mutation]]
 
*[[Familial hemiplegic migraine]]
 
*[[Familial hypercholesterolemia]]
 
*[[Fibromuscular dysplasia]]
'''For patient information, click [[Hirsutism (patient information)|here]]'''
*[[Giant cell arteritis]]
 
*[[Hemophilia A]]
{{Infobox_Disease |
*[[Heparin-induced thrombocytopenia]]
  Name          = {{PAGENAME}} |
*[[Hereditary hemorrhagic telangiectasia]]
  Image          = |Nuremberg chronicles - Strange People - Hairy Lady (XIIv).jpg
*HERNS syndrome<ref name="JenCohen1997">{{cite journal|last1=Jen|first1=J.|last2=Cohen|first2=A. H.|last3=Yue|first3=Q.|last4=Stout|first4=J. T.|last5=Vinters|first5=H. V.|last6=Nelson|first6=S.|last7=Baloh|first7=R. W.|title=Hereditary endotheliopathy with retinopathy, nephropathy, and stroke(HERNS)|journal=Neurology|volume=49|issue=5|year=1997|pages=1322–1330|issn=0028-3878|doi=10.1212/WNL.49.5.1322}}</ref><ref name="pmid15856153">{{cite journal| author=Seifried C, Sitzer M, Jen J, Auburger G| title=[HERNS. A rare, hereditary, multisystemic disease with cerebral microangiopathy]. | journal=Nervenarzt | year= 2005 | volume= 76 | issue= 10 | pages= 1191-2, 1194-5 | pmid=15856153 | doi=10.1007/s00115-005-1910-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15856153  }} </ref>
  Caption        = |A lady with hirsutism, as depicted in the ''Nuremberg Chronicle'' (1493)
*[[HIV]]
        = |
*[[Homocystinuria]]
}}
*[[Hutchinson-Gilford progeria syndrome]]
{{SI}}
*[[Hyperhomocysteinemia]]
{{CMG}}
*[[Hyperlipoproteinemia ]]  
 
*[[Hypertension ]]
==Overview==
*[[Hypoxemia]]
'''Hirsutism''' (from Latin ''hirsutus'' = shaggy, hairy) is defined as excessive and increased [[hair]] growth in women in locations where the occurrence of [[terminal hair]] normally is minimal or absent. It refers to a male pattern of body hair ([[androgenic hair]]) and it is therefore primarily of cosmetic and [[psychological]] concern. Hirsutism is a [[symptom]] rather than a [[disease]] and may be a sign of a more serious medical indication, especially if it develops well after [[puberty]].
*[[Idiopathic pulmonary fibrosis]]
 
*[[substance abuse|Illicit drug use]]
== Appearance and evaluation ==
*[[Infective endocarditis]]
Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their [[puberty]] ([[chest hair|chest]], [[abdominal hair|abdomen]], back and [[facial hair|face]]). The medical term for excessive hair growth that affect both men and women is [[hypertrichosis]].
*Internal carotid agenesis
 
*[[intracranial aneurysms|Internal carotid artery aneurysm]]
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.
*[[Intracerebral hemorrhage]]
*[[cerebral arteriovenous malformation|Intracranial arteriovenous malformation]]
==Etiology==
*[[Intracranial berry aneurysm]]
The cause of hirsutism can be either an increased level of [[androgen]]s (male [[hormone]]s) or an oversensitivity of [[hair follicles]] to androgens. Male hormones such as [[testosterone]] stimulate hair growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a high level of male hormones include [[Acne vulgaris|acne]] and deepening of the voice and increased muscle mass.
*[[Intracranial hemorrhage]]
 
*[[Ischemia]]
Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.
*[[Lacunar infarcts]]
 
*[[Lacunar stroke]]
It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.
*[[Left atrial myxoma]]
 
*[[thrombus|Left atrial thrombus]]  
The following may be some of the conditions that may increase a woman's normally low level of male hormones:
*[[Left ventricular aneurysm]]
* [[Polycystic ovary syndrome]]  
*[[Left ventricular thrombus]]  
* [[Cushing's disease]]  
*[[Libman-Sacks endocarditis]]
* [[Tumor]]s in the [[ovaries]] or [[adrenal gland]] ([[cancer]])
*Lipohyalinosis
* [[Congenital adrenal hyperplasia]]
*[[lipoprotein disorders classification|Lipoproteinemia]]
* [[Insulin resistance]]
*[[Lupus]]
* Drugs like [[Ciclosporin]], [[conjugated estrogens]], [[Desogestrel and Ethinyl Estradiol]], [[Dexamethasone]], [[ethynodiol diacetate and ethinyl estradiol]], [[Ethosuximide]], [[Fluoxymesterone]], [[Methyltestosterone]], [[Oxandrolone]], [[Oxymetholone]], [[prednisolone]], [[Tiagabine]]
*[[Malignant  hypertension ]]
 
*[[Marantic endocarditis ]]
== Physical Examination ==
*[[Mechanical heart valves]]
====Skin====
*[[MELAS]]
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
*[[Menkes disease]]
<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]
*[[Methamphetamine overdose]]  
{{clr}}
*[[Methylmalonic acidemia]]
 
*[[Methylmalonic aciduria ]]
==Differential Diagnosis of Causes of {{PAGENAME}}==
*[[Migraine ]]
 
*[[Mitochondrial diseases ]]  
#Idiopathic:
*[[Mitral annular calcification]]  
#*familial,
*[[Mitral valve prolapse ]]
#*possibly increased sensitivity to androgens.
*[[Moyamoya disease ]]
#variant of normal menopause.
*[[Multi-infarct dementia]]
#Polycystic ovarian syndrome.
*[[Myocardial infarction ]]  
#obesity
*[[Narcotic addiction]]
#Drugs:
*[[Neurosyphilis]]
#*androgens,
*[[Osteopetrosis ]]
#*anabolic steroids,
*[[Papillary fibroelastoma]]  
#*methyltestosterone,
*[[Patent foramen ovale]]
#*minoxidil,
*[[Pericardial effusion]]
#*diazoxide,
*[[Polycythemia vera ]]
#*phenytoin,
*[[Posterior inferior cerebellar artery syndrome]]
#*glucocorticoids,
*[[Pre-eclampsia ]]
#*cyclosporine.
*[[Premature aging ]]
#*phenytoin,
*[[vasculitis|Primary angiitis]]  
#Congenital adrenal hyperplasia.
*[[Progeria ]]
#Adrenal virilizing tumor.
*[[Protein C deficiency]]
#Ovarian virilizing tumor:
*[[Protein S deficiency]]
#*arrhenoblastoma,
*[[Pulmonary arterio-venous malformation]]
#*hilus cell tumor.
*[[Pulmonary embolism]]
#Pituitary adenoma.
*[[Rheumatic heart disease]]
#pregnancy
*[[Rheumatoid vasculitis]]
#Insulin resistance
*[[Sick sinus syndrome]]
#Cushing's syndrome.
*[[Sickle cell anemia]]
#Hypothyroidism (congenital and juvenile).
*[[Sickle cell disease]]
#Acromegaly.
*[[Sleep apnea ]]
#Androgen-secreting tumors of the ovaries
*[[Sneddon-Champion syndrome ]]
#*Sertoli-Leydig cell tumors,
*[[Spondyloepiphyseal dysplasia]]
#*granulosa-theca cell tumors,
*[[Sturge-Weber syndrome]]
#*hilus-cell tumors
*[[Subarachnoid haemorrhage]]
#hyperprolactinemia
*[[Substance abuse]]
#Testicular feminization.
*[[atrial flutter|Sustained atrial flutter]]
 
*[[Syphilis]]
== Treatment ==
*[[Systemic hypertension]]
Many women with unwanted hair seek methods of [[hair removal]] to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.
*[[Systemic lupus erythematosus]]
 
*[[Takayasu arteritis]]
== See also ==
*[[essential thrombocytosis|Thrombocythemia]]
* [[androgenic hair]]
*[[Thromboembolism]]
* [[hypertrichosis]]  
*[[Thrombosis]]
* [[hair removal]]  
*[[Thrombotic thrombocytopenic purpura]]
*[[Transient ischemic attack]]
*[[Trauma]]
*[[Vascular dementia]]
*[[cerebral arteriovenous malformation|Vascular malformations]]
*[[Vasculitis]]
*[[Vasoconstriction]]
*[[Velocardiofacial syndrome]]
*[[Ventricular aneurysm]]
*[[Vertebral artery dissection]]
*[[Wegener's granulomatosis]]
*[[Werner syndrome]]
*[[Wolfram syndrome]]


==References==
==References==
{{Reflist|2}}
* Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. ''Journal of Clinical Endocrinology'' 1961; 21:1440-1447.


==Causes of Stroke==
===Ischemic Stroke===
====Thrombotic Stroke====
Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on:


* '''Large vessel disease''' involves the common and [[internal carotid artery|internal carotids]], [[vertebral artery|vertebral]], and the [[Circle of Willis]]. Diseases that may form thrombi in the large vessels include (in descending incidence):
{{Diseases of the skin and subcutaneous tissue}}
** [[Arteritis]]/[[vasculitis]]
 
** [[Atherosclerosis]]
 
** [[Aortic dissection|Dissection]]
[[Category:Integumentary system]]
** [[Fibromuscular dysplasia]]
[[Category:Gynecology]]
** [[Giant cell arteritis]]
[[Category:Dermatology]]
** [[Moyamoya syndrome]]
[[Category:Hair-related diseases]]
** Noninflammatory vasculopathy
 
** [[Takayasu arteritis]]
<!-- The below are interlanguage links. -->
** [[Vasoconstriction]]
 
   
<br>
* '''Small vessel disease''' involves the intracerebral arteries, branches of the Circle of Willis, [[middle cerebral artery]], stem, and arteries arising from the distal vertebral and [[basilar artery]]. Diseases that may form thrombi in the small vessels include (in descending incidence):
[[bg:Хирзутизъм]]
** Lipohyalinosis (lipid hyaline build-up secondary to hypertension and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts)
[[de:Hirsutismus]]
** Microatheromas from larger arteries that extend into the smaller arteries (atheromatous branch disease)
[[et:Hirsutism]]
[[es:Hirsutismo]]
[[fr:Hirsutisme]]
[[id:Hirsutisme]]
[[nl:Hirsutisme]]
[[pl:Hirsutyzm]]
[[pt:Hirsutismo]]
 
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


====Embolic Stroke====
=====High Risk Cardiac Causes<ref name="ay">{{cite journal | author=  Ay H; Furie KL; Singhal A; Smith WS; Sorensen AG; Koroshetz WJ | title=  An evidence-based causative classification system for acute ischemic stroke | journal=  Ann Neurol | year=2005 | pages=688-97 | volume=58 | issue=5 | id=PMID 16240340}}</ref>=====
* [[Antiphospholipid syndrome]]
* [[Atrial fibrillation]] and [[paroxysmal atrial fibrillation]]
* Atrial or ventricular thrombus
* Bioprosthetic and [[Artificial heart|mechanical heart]] valves
* Chronic myocardial infarction together with [[ejection fraction]] <28 percent
* [[Coronary artery bypass graft]] ([[CABG]]) surgery
* [[Dilated cardiomyopathy]]
* [[Infective endocarditis]]
* [[Left atrial myxoma]]
* [[Libman-Sacks endocarditis]]
* [[Marantic endocarditis]] from cancer
* [[Papillary fibroelastoma]]
* Recent [[myocardial infarction]] (within one month)
* Rheumatic mitral or [[aortic valve]] disease
* [[Sick sinus syndrome]]
* Sustained [[atrial flutter]]
* Symptomatic [[congestive heart failure]] with ejection fraction <30 percent


=====Potential Cardiac Causes=====
* Atrial septal [[aneurysm]]
* Atrial septal aneurysm with patent foramen ovale
* Complex atheroma in the [[ascending aorta]] or proximal arch
* Isolated left atrial smoke on echocardiography (no [[mitral stenosis]] or atrial fibrillation)
* Left ventricular aneurysm without thrombus
* Mitral annular calcification
* [[Patent foramen ovale]]


====Systemic Hypoperfusion (Watershed stroke)====
* [[Cardiac arrest]]
* Cardiac arrhythmias
* Reduced [[cardiac output]] as a result of
** Bleeding
** [[Myocardial infarction]]
** [[Pericardial effusion]]
** [[Pulmonary embolism]]


[[Hypoxia (medical)|Hypoxemia]] (low blood oxygen content) may precipitate the hypo-perfusion.


===Hemorrhagic Stroke===
====Intracerebral Hemorrhage====
* [[Amyloid angiopathy]]
* [[Haemophilia|Bleeding disorders]]
* [[Hypertension]]
* [[Drug use|Illicit drug use]] (e.g., [[amphetamines]] or [[cocaine]])
* Trauma
* Vascular malformations


==References==
{{Reflist|2}}


[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Medical emergencies]]
[[Category:Emergency medicine]]


{{WH}}
{{WS}}






The upper part of the GI tract will usually cause black stools due to:
* Abnormal [[blood vessel]]s (vascular [[malformation]])
* A tear in the esophagus from violent vomiting ([[Mallory-Weiss tear]])
* Bleeding stomach or [[duodenal ulcer]]
* Inflammation of the stomach lining ([[gastritis]])
* Lack of proper blood flow to the intestines ([[bowel]] [[ischemia]])
* Trauma or foreign body
* Widened, overgrown veins (called [[varices]]) in the esophagus and stomach




Line 274: Line 205:
{{familytree | H01 | | | | H02 | | | | H03 | |H01=|H02=|H03=}}
{{familytree | H01 | | | | H02 | | | | H03 | |H01=|H02=|H03=}}
{{familytree/end}}
{{familytree/end}}




Line 304: Line 225:




*[[Adenine phosphoribosyltransferase deficiency]]
*[[Allopurinol]]
*[[Aniline]]
*[[Behcet's disease]]
*[[Benign prostatic hyperplasia]]
*[[Benzidine]]
*[[Bladder incontinence]]
*[[Bladder stones]]
*[[Bleomycin]]
*[[Candida]]
*[[Carbenicillin]]
*[[Cetirizine]]
*[[Chemical cystitis]]
*[[Chlamydia]]
*[[Chlordimeform]]
*[[Congenital abnormalities of the urinary tract]]
*[[Crohn's disease]]
*[[Cyclophosphamide]]
*[[Cystoscopy]]
*[[Danazol]]
*[[Dehydration]]
*[[Diabetes]]
*[[Diabetic neuropathy]]
*[[Diaphragm]]
*[[Diarrhea]]
*[[Diverticulitis]]
*[[Doxorubicin]]
*[[Drug induced cystitis]]
*[[Endometriosis]]
*[[Enterobacter]]
*[[Episiotomy scar infection]]
*[[Escherichia coli]]
*[[Ether]]
*[[Foreign body cystitis]]
*[[Gonorrhea]]
*[[carcinoma|Gynecological cancers]]
*[[Hemorrhagic cystitis]]
*[[Honeymoon cystitis]]
*[[Hunner's ulcer]]
*[[Ifosfamide]]
*[[Immobility]]
*[[Interstitial cystitis]]
*[[acetic acid|Intravesical acetic acid]]
*[[Kidney stones]]
*[[Klebsiella]]
*[[Lupus]]
*[[Methaqualone]]
*[[Methenamine mandelate]]
*[[Methicillin]]
*[[Methotrexate]]
*[[Mucoepithelial dysplasia, Witkop type]]
*[[nonoxynol-9|Nonoxynol-9 suppositories]]
*[[NSAIDS]]
*[[Penicillin VK]]
*[[Penicillins]]
*[[PID]]
*[[Piperacillin]]
*[[Posterior urethral valves]]
*[[Prostatitis]]
*[[Pseudomonas aeruginosa]]
*[[Radiotherapy]]
*[[Schistosomiasis]]
*[[Serratia]]
*[[Sexually transmitted diseases]]
*[[spermicide|Spermicidal jellies]]
*[[Spinal cord injury]]
*[[Staphylococcus saprophyticus]]
*[[Tampon]]
*[[Temozolomide]]
*[[Tiaprofenic acid]]
*[[Ticarcillin]]
*[[Toluidine]]
*[[Trichomoniasis]]
*[[Tuberculosis]]
*[[Urachal cancer]]
*[[Urachal cyst]]
*[[Urethral syndrome]]
*[[Urethritis]]
*[[Urinary catheter]]
*[[Urinary obstruction]]
*[[Urinary stones]]
*[[Urofacial syndrome]]
*[[Vesicoenteric fistula]]
*[[Xanthinuria]]
==References==
{{Reflist|2}}


==Overview==
==Overview==

Latest revision as of 02:18, 14 September 2017

Diagnosis Incidence Onset Common symptom
❑ Polycystic ovary syndrome

❑ Idiopathic hirsutism

❑ Congenital adrenal hyperplasia

❑ Ovarian and androgen secreting tumors

❑ Drug induced

❑ HAIR-AN Syndrome

❑ 70-85%

❑ 5-15%

❑ 1-8%

❑ 0.3-0.1%


❑ 0.5-1%


❑ 3-4%

❑ PCOS insidious

❑ Idiopathic hirsutism Insidious
❑ CAH rapid

❑ Tumors rapid



❑ HAIRAN syndrome insidious

❑ Irregular menses, hyperandrogenism, polycystic ovary
❑ No other known cause, normal ovaries, normal anbdrogens


❑ Total testosterone > 200ng and does not respond to treatment

❑ Related to medications (steroids, danazol etc)

❑ Subset of PCOS with insulin resistance and acanthosis nigricans










For patient information, click here

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical indication, especially if it develops well after puberty.

Appearance and evaluation

Hirsutism only affects women, since the rising of androgens causes a male pattern of body hair, particularly in locations where women normally do not develop terminal hair within their puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.

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.

Etiology

The cause of hirsutism can be either an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a high level of male hormones include acne and deepening of the voice and increased muscle mass.

Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.

It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.

The following may be some of the conditions that may increase a woman's normally low level of male hormones:

Physical Examination

Skin

hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor) [1]

Differential Diagnosis of Causes of Sandbox Ochuko

  1. Idiopathic:
    • familial,
    • possibly increased sensitivity to androgens.
  2. variant of normal menopause.
  3. Polycystic ovarian syndrome.
  4. obesity
  5. Drugs:
    • androgens,
    • anabolic steroids,
    • methyltestosterone,
    • minoxidil,
    • diazoxide,
    • phenytoin,
    • glucocorticoids,
    • cyclosporine.
    • phenytoin,
  6. Congenital adrenal hyperplasia.
  7. Adrenal virilizing tumor.
  8. Ovarian virilizing tumor:
    • arrhenoblastoma,
    • hilus cell tumor.
  9. Pituitary adenoma.
  10. pregnancy
  11. Insulin resistance
  12. Cushing's syndrome.
  13. Hypothyroidism (congenital and juvenile).
  14. Acromegaly.
  15. Androgen-secreting tumors of the ovaries
    • Sertoli-Leydig cell tumors,
    • granulosa-theca cell tumors,
    • hilus-cell tumors
  16. hyperprolactinemia
  17. Testicular feminization.

Treatment

Many women with unwanted hair seek methods of hair removal to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.

See also

References

  • Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. Journal of Clinical Endocrinology 1961; 21:1440-1447.




bg:Хирзутизъм de:Hirsutismus et:Hirsutism id:Hirsutisme nl:Hirsutisme


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Primary treatment option
Atropine
❑ Administer a first dose 0.5 mg IV bolus
❑ Repeat every 3-5 minutes
❑ Administer a maximum dose of 3 mg
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Secondary treatment options
If atropine ineffective:
❑ Administer dopamine infusion (2-10 mcg/kg/min)
OR
❑ Administer epinephrine infusion (2-10 mcg/min)
OR
❑ Proceed with transcutaneous pacing
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Consult a cardiologist
❑ Consider transvenous pacing
 
 
 
 
 
 




Overview

Causes

Life Threatening Causes

Common Causes

Diagnosis

Focused Initial Rapid Evaluation

Complete Evaluation

 
 
 
 
 
 
 
 
A01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
C01
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
D01
 
 
 
 
 
 
 
 
 
 
 
D02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
E01
 
 
 
 
 
 
 
 
 
 
 
E02
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
F01
 
 
 
 
 
 
 
 
 
 
 
 


Treatment

Do's

Don'ts

References

  1. ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages/

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