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{{familytree/start}}
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
{{familytree | | | | | | | | | A01 | | | |A01=}}
|-
{{familytree | | | | | | | | | |!| | | | |}}
| 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'''
{{familytree | | | | | | | | | B01 | | | |B01=}}
|-
{{familytree | | | | | | | | | |!| | | | |}}
| style="font-size: 90%; padding: 0 10px; background: #DCDCDC" align=left |❑ [[Polycystic ovary syndrome]] <br>
{{familytree | | | | | | | | | C01 | | | | |C01=}}
 
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|.|}}
❑ [[hirsutism|Idiopathic hirsutism]]<br>
{{familytree | | D01 | | | | | D02 | | | | | | | | D03 | |D01=|D02=|D03=}}
 
{{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}}
❑ [[Congenital adrenal hyperplasia]] <br>
{{familytree | | |!| | | | | | E01 | | | | | | | | E02 | |E01=|E02=}}
 
{{familytree | | |!| | | | | | |!| | | | | | | | | |!| |}}
❑ Ovarian and androgen secreting tumors <br>
{{familytree | | |!| | | | | | F01 | | | | | | | | F02 |F01=|F02=}}
 
{{familytree | | |!| | | | |,|-|^|-|-|.| | | | |,|-|^|-|-|.|}}
❑ Drug induced <br>
{{familytree | | |!| | | | G01 | | | G02 | | | G03 | | | G04 | G01=|G02=|G03=|G04=}}
 
{{familytree | | |!| | | | |!| | | | | | | | | | | | | | |!| |}}
❑ [[HAIR-AN Syndrome]] <br>
{{familytree | | |`|-|-|-| H01 | | | | | | | | | | | | | H03 | |H01=|H02=|H03=}}
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ 70-85%<br><br> ❑ 5-15%<br><br> ❑ 1-8%<br><br>
{{familytree/end}}
❑ 0.3-0.1%<br>
 
 
❑ 0.5-1% <br>
 
 
❑ 3-4%
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |❑ PCOS insidious<br> 
 
❑ Idiopathic hirsutism Insidious<br>
❑ CAH rapid <br><br>
❑ Tumors rapid <br>
 
 
 
 
 
❑ HAIRAN syndrome insidious
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |
❑ Irregular menses, hyperandrogenism, polycystic ovary <br>
❑ No other known cause, normal ovaries, normal anbdrogens <br>
 
 
 
❑ Total testosterone > 200ng and does not respond to treatment <br>
 
❑ Related to medications (steroids, danazol etc) <br>
 
❑ Subset of PCOS with insulin resistance and acanthosis nigricans
|}
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
'''For patient information, click [[Hirsutism (patient information)|here]]'''
 
{{Infobox_Disease |
  Name          = {{PAGENAME}} |
  Image          = |Nuremberg chronicles - Strange People - Hairy Lady (XIIv).jpg
  Caption        = |A lady with hirsutism, as depicted in the ''Nuremberg Chronicle'' (1493)
        = |
}}
{{SI}}
{{CMG}}
 
==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 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]].
 
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 [[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.


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:
* [[Polycystic ovary syndrome]]
* [[Cushing's disease]]
* [[Tumor]]s in the [[ovaries]] or [[adrenal gland]] ([[cancer]])
* [[Congenital adrenal hyperplasia]]
* [[Insulin resistance]]
* Drugs like [[Ciclosporin]], [[conjugated estrogens]], [[Desogestrel and Ethinyl Estradiol]], [[Dexamethasone]], [[ethynodiol diacetate and ethinyl estradiol]], [[Ethosuximide]], [[Fluoxymesterone]], [[Methyltestosterone]], [[Oxandrolone]], [[Oxymetholone]], [[prednisolone]], [[Tiagabine]]


== Physical Examination ==
====Skin====
[[Image:hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor).jpg|thumb|left|hirsuitism (PCOS, Cushing's Syndrome, Phenytoin, Leydig Cell Tumor)
<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/</ref>]]
{{clr}}


==Differential Diagnosis of Causes of {{PAGENAME}}==


#Idiopathic:
#*familial,
#*possibly increased sensitivity to androgens.
#variant of normal menopause.
#Polycystic ovarian syndrome.
#obesity
#Drugs:
#*androgens,
#*anabolic steroids,
#*methyltestosterone,
#*minoxidil,
#*diazoxide,
#*phenytoin,
#*glucocorticoids,
#*cyclosporine.
#*phenytoin,
#Congenital adrenal hyperplasia.
#Adrenal virilizing tumor.
#Ovarian virilizing tumor:
#*arrhenoblastoma,
#*hilus cell tumor.
#Pituitary adenoma.
#pregnancy
#Insulin resistance
#Cushing's syndrome.
#Hypothyroidism (congenital and juvenile).
#Acromegaly.
#Androgen-secreting tumors of the ovaries
#*Sertoli-Leydig cell tumors,
#*granulosa-theca cell tumors,
#*hilus-cell tumors
#hyperprolactinemia
#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 ==
* [[androgenic hair]]
* [[hypertrichosis]]
* [[hair removal]]


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




{{Diseases of the skin and subcutaneous tissue}}




[[Category:Integumentary system]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]


<!-- The below are interlanguage links. -->


<br>
[[bg:Хирзутизъм]]
[[de:Hirsutismus]]
[[et:Hirsutism]]
[[es:Hirsutismo]]
[[fr:Hirsutisme]]
[[id:Hirsutisme]]
[[nl:Hirsutisme]]
[[pl:Hirsutyzm]]
[[pt:Hirsutismo]]


{{WikiDoc Help Menu}}
{{WikiDoc Sources}}




{{family tree/start}}
{{Family tree | E01 | | | | |E01='''Primary treatment option''' <br> '''[[Atropine]]'''<br><div style="float: left; text-align: left; line-height: 150% ">
❑ Administer a first dose 0.5 mg IV bolus <br> ❑ Repeat every 3-5 minutes <br> ❑ Administer a maximum dose of 3 mg </div>}}
{{Family tree | |!| | | | | | | | }}
{{Family tree | E03 | | | | E03='''Secondary treatment options'''<br>'''If atropine ineffective:'''<br><div style="float: left; text-align: left; line-height: 150% "> ❑ Administer [[dopamine]] infusion (2-10 mcg/kg/min) <br> OR <br> ❑ Administer [[epinephrine]] infusion (2-10 mcg/min) <br> OR <br> ❑ Proceed with [[transcutaneous pacing]]</div>}}
{{family tree | |!| | | | | | | | }}
{{family tree | F01 | | | | | | |F01=<div style="float: left; text-align: left; line-height: 150% "> ❑ Consult a cardiologist <br> ❑ Consider [[transvenous pacing]] </div>}}
{{Family tree/end}}




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*[[Adenine phosphoribosyltransferase deficiency]]
{{familytree/start}}
*[[Allopurinol]]
{{familytree | | | | | | | | | A01 | |A01=}}
*[[Aniline]]
{{familytree | | | | | | | | | |!| | |}}
*[[Behcet's disease]]
{{familytree | | | | | | | | | B01 | |B01=}}
*[[Benign prostatic hyperplasia]]
{{familytree | | | | | | | | | |!| | |}}
*[[Benzidine]]
{{familytree | | | | | | | | | C01 | | |C01=}}
*[[Bladder incontinence]]
{{familytree | | | | | |,|-|-|-|+|-|-|-|.| |}}
*[[Bladder stones]]
{{familytree | | | | | D01 | | D02 | | D03 | |D01=|D02=|D03=}}
*[[Bleomycin]]
{{familytree | | | | | |!| | | |!| | | |!| |}}
*[[Candida]]
{{familytree | | | | | E01 | | E02 | | E03 | |E01=|E02=|E03=}}
*[[Carbenicillin]]
{{familytree | | | | | |!| | | |!| | | | | |}}
*[[Cetirizine]]
{{familytree | | | | | F01 | | F02 | | | |F01=|F02=}}
*[[Chemical cystitis]]
{{familytree | |,|-|-|-|(| | | |)|-|-|-|.| |}}
*[[Chlamydia]]
{{familytree | G01 | | G02 | | G03 | | G04 | |G01=|G02=|G03=|G04=}}
*[[Chlordimeform]]
{{familytree | |!| | | |`|-|v|-|'| | | |!| | |}}
*[[Congenital abnormalities of the urinary tract]]
{{familytree | H01 | | | | H02 | | | | H03 | |H01=|H02=|H03=}}
*[[Crohn's disease]]
{{familytree/end}}
*[[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]]




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{{family tree/start}}
{{Family tree | E01 | | | | |E01='''Primary treatment option''' <br> '''[[Atropine]]'''<br><div style="float: left; text-align: left; line-height: 150% ">
❑ Administer a first dose 0.5 mg IV bolus <br> ❑ Repeat every 3-5 minutes <br> ❑ Administer a maximum dose of 3 mg </div>}}
{{Family tree | |!| | | | | | | | }}
{{Family tree | E03 | | | | E03='''Secondary treatment options'''<br>'''If atropine ineffective:'''<br><div style="float: left; text-align: left; line-height: 150% "> ❑ Administer [[dopamine]] infusion (2-10 mcg/kg/min) <br> OR <br> ❑ Administer [[epinephrine]] infusion (2-10 mcg/min) <br> OR <br> ❑ Proceed with [[transcutaneous pacing]]</div>}}
{{family tree | |!| | | | | | | | }}
{{family tree | F01 | | | | | | |F01=<div style="float: left; text-align: left; line-height: 150% "> ❑ Consult a cardiologist <br> ❑ Consider [[transvenous pacing]] </div>}}
{{Family tree/end}}





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


Template:WikiDoc Sources







 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 




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

Template:WH Template:WS