General Medicine Conference
“Hirsutism”
Selim Krim, MD
Assistant professor
Texas Tech University Health Sciences Center
OBJECTIVES
Define hirsutism
Get familiar with the Ferriman-Gallway scale to evaluate
the extent of hair growth
Understand the pathogenesis of hirsutism
Be familiar with available therapies
Use a stepwise approach when evaluating for hirsutism
CASE
A 19-year-old woman seeks care for slowly progressive hair
growth. Since high school, she has shaved her upper lip weekly and
waxed her abdomen and thighs monthly. Her menstrual periods are
regular. Physical examination is unremarkable except for a bodymass index (the weight in kilograms divided by the square of the
height in meters) of 31 and trace hair over the abdomen and thighs,
with a moderate amount over her back. There is no clitorimegaly.
How should this patient be evaluated and treated?
DEFINITION
“Excessive terminal hair that appears in a male pattern (i.e., sexual
hair) in women”
Deplewski et al. Endocr Rev 2000;21:363-92
CLASSIFICATION
PATHOGENESIS
DIFFERENTIAL DIAGNOSIS
HYPERTRICHOSIS
Generalized excessive hair growth secondary to heredity
or medications ( Steroids, phenytoin, Cyclosporine).
Hair is distributed in a generalized, non sexual pattern.
Not caused by excess of androgens
ETIOLOGIES
Normal androgen levels:
Idiopathic hirsutism
Excess androgen levels:
Polycystic ovary syndrome
Congenital adrenal hyperplasia
Androgen secreting tumors
Cushing’s syndrome
Hyperprolactinemia
Acromegaly
Thyroid dysfunction
Androgenic medications
DIAGNOSIS
History and physical exam helps ruling out other causes
of virilizing disorders, polycystic ovary syndrome,
medication use or other endocrinopathies.
Look for evidence of anovulation, obesity, metabolic
syndrome.
A rapid pace of development or progression of hirsutism
or evidence of virilization (Clitoromegaly or increasing
muscularity) should raise concern that an androgensecreting tumor is present
STEPWISE APPROACH TO HIRSUTISM
MANAGEMENT
Cosmetic and physical measures
Hormonal treatments
Estrogen-progestin oral contraceptives
Antiandrogens
Other hormonal therapies: (Glucocorticoids, 5 alphareductase inhibitors, metformin and thaizolidinediones)
AVAILABLE THERAPY
CASE
A 19-year-old woman seeks care for slowly progressive hair growth.
Since high school, she has shaved her upper lip weekly and waxed her
abdomen and thighs monthly. Her menstrual periods are regular. Physical
examination is unremarkable except for a body-mass index (the weight in
kilograms divided by the square of the height in meters) of 31 and trace hair
over the abdomen and thighs, with a moderate amount over her back.
There is no clitorimegaly. How should this patient be evaluated and treated?
Based on Ferriman-Gallway scale, this patient has mild hirsutism
There are no signs of virilization and her menstrual cycles are regular
However the increase in her weight may warrant further testing
Free testosterone levels
CASE
A trial of eflornithine chloride cream may be tried for facial hirsutism
Encourage weight control
If hirsutism remains uncontrolled, oral contraceptives may be used
over a 9 to 12 months period
May also discuss the potential permanent benefit, risks, and cost of
laser hair removal
Questions ?
Thank you