Hirsutism is excessive body hair in men and women in body parts where hair is usually absent or minimal, as in chin or chest in particular, or face or body in general. This may refer to male hair growth patterns that may be a sign of a more serious medical condition, especially if it develops well after puberty. This can be caused by elevated levels of the androgen hormone. The number and location of hair is measured by Ferriman-Gallwey score. This is different from hypertrichosis, ie excessive hair growth anywhere in the body.
Hirsutism usually results from an underlying endocrine imbalance, which may be adrenal, ovary, or central. Hirsutism is a symptom that often arises in dermatology, endocrinology, and gynecology clinics, and one that is considered to be the cause of much psychological pressure and social difficulties. Facial hirsutism often leads to avoidance of social situations and symptoms of anxiety and depression.
Hirsutism affects between 5-15% of all women in all ethnic backgrounds. Depending on the definition and the underlying data, estimates show that about 40% of women have some unwanted facial hair levels.
Video Hirsutism
Signs and symptoms
Hirsutism affects members of both sexes, as increased androgen levels can cause excess body hair, especially in locations where women usually do not develop terminal hair during puberty (chest, abdomen, back, and face). The medical term for excessive hair growth that affects any gender is hypertrichosis.
Maps Hirsutism
Cause
Hirsutism can be caused by elevated levels of androgen, male hormones, or excessive sensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify hair growth and pigmentation. Other symptoms associated with high levels of male hormones include acne, deepening of voice, and increased muscle mass. This condition is called hyperandrogenism.
More evidence implies the high levels of insulin circulating in women for the development of hirsutism. This theory is speculated to be consistent with the observation that obese women (and thus suspected hyperinsulinemic resistant insulin) are at high risk of becoming hirsutism. Furthermore, treatment that lowers insulin levels will lead to a decrease in hirsutism.
It is speculated that insulin, at a fairly high concentration, stimulates the ovarian tekaa cells to produce androgens. There may also be an effect of high insulin levels to activate the insulin growth factor receptor (IGF-1) in the same cells. Again, the result is an increase in androgen production.
The suggestive signs of androgen-secreting tumors in patients with hirsutism are rapid onset, virilization and a palpable abdominal mass.
The following are conditions and situations that have been linked to hyperandrogenism and hence hirsutism in women:
- Hyperinsulinemia (excess insulin) or hypoinsulinemia (insulin deficiency or resistance as in diabetes).
- Ovarian cysts as in polycystic ovary syndrome (PCOS), the most common cause in women.
- Ovarian tumors such as granulosa tumors, thecomas, Sertoli-Leydig (androblastomas) cell tumors, and gynandroblastomas, as well as ovarian cancer.
- Hyperthecosis.
- Pregnancy.
- Adrenal gland tumors, adrenocortical adenomas, and adrenocortical carcinoma, as well as adrenal hyperplasia due to pituitary adenoma (as in Cushing's syndrome).
- tumors that secrete hCG
- The inherent errors of steroid metabolism such as congenital adrenal hyperplasia, most commonly caused by 21-hydroxylase deficiency.
- Acromegaly and gigantism (growth hormone and excess IGF-1), usually due to pituitary tumors.
- Use of certain drugs such as androgens/anabolic steroids, phenytoin, and minoxidil.
The causes of hirsutism that are not associated with hyperandrogenism include:
- Porphyria cutanea tarda.
- Minoxidil
Diagnosis
A complete physical evaluation should be undertaken prior to commencing a broader study, the examiner should distinguish between increased body hair extensions and male pattern virilization. One method of evaluating hirsutism is the Ferriman-Gallwey Score that gives a score based on the number and location of hair growth in a woman. After a physical examination, laboratory research and imaging studies can be done to rule out further causes.
The diagnosis of patients with mild hirsutism should include ovulation and ovarian ultrasound assessment, due to the high prevalence of polycystic ovary syndrome (PCOS), and 17? -hydroxyprogesterone (due to the possibility of finding non-classic 21-hydroxylase deficiency). Many women experience elevated serum levels of dehydroepiandrosterone sulfate (DHEA-S). Levels greater than 700? G/dL is indicative of adrenal gland dysfunction, particularly congenital adrenal hyperplasia due to 21-hydroxylase deficiency. However, PCOS and idiopathic hirsutism make up 90% of cases.
Other values ​​of blood that can be evaluated in hirsutic examination include:
- androgen; androstenedione, testosterone
- thyroid function panel; thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4)
- prolactin
If no underlying cause can be identified, this condition is considered idiopathic.
Treatment
Many women with unwanted hair look for hair removal methods. However, the cause of hair growth should be evaluated by a doctor, who can perform blood tests, determine the specific origin of abnormal hair growth, and advise on treatment.
Drugs
Drugs consist mostly of antiandrogens, drugs that block androgen effects such as testosterone and dihydrotestosterone (DHT) in the body, and include:
- Spironolactone: Antimineralocorticoid with additional antiandrogenic activity at high doses
- Cyproterone acetate: Double antigen and progestogen. In addition to a single form, it is also available in some low-dose oral contraceptive combination formulations (see below). It has a risk of liver damage.
- Flutamide: pure Antiandrogen. It has been found to have equivalent or greater effectiveness than spironolactone, cyproterone acetate, and finasteride in the treatment of hirsutism. However, it has a high risk of liver damage and is therefore no longer recommended as first or second line treatment. A meta-analysis shows that a dose of 250 mg twice a day of flutamide is safe and effective for hirsutism.
- Bicalutamide: pure Antiandrogen. This is effectively similar to flutamide but is much safer and better tolerated.
- Birth control pills: Consists of estrogen, usually ethinylestradiol, and progestin. They are thought to work by 1) stimulating the production of sex hormone-binding globulin in the liver, which lowers testosterone-free concentration in the blood; and by 2) suppresses luteinizing hormone (LH) secretion from the pituitary gland, which decreases testosterone production by gonads. Therefore, they are functional antiandrogens. In addition, certain birth control pills contain progestin which also has antiandrogenic activity. Examples include birth control pills that contain cyproterone acetate, chlormadinone acetate, drospirenone, and dienogest. A meta-analysis of randomized controlled trials supports the effectiveness of oral contraceptives for mild hirsutism.
- Finasteride and dutasteride: 5? -Reductase inhibitor. They inhibit the production of potent DHT androgens. A meta-analysis shows inconsistent results from finasteride in the treatment of hirsutism.
- GnRH analogue: Suppresses androgen production by gonads and reduces androgen concentrations to castrate levels.
- Metformin: Antihyperglycemic drugs are used for diabetes mellitus and hirsutism treatment associated with insulin resistance (eg polycystic ovary syndrome). A meta-analysis found that metformin is not effective in the treatment of hirsutism, although the evidence has low quality.
- Eflornithine: Blocks putrescine necessary for growth of hair follicles
In the case of special hyperandrogenism due to congenital adrenal hyperplasia, administration of glucocorticoids will restore androgen levels to normal.
Other methods
- Feather shave
- Waxing
- Shave
- Laser hair removal
- Electrology
- Lifestyle changes, including reducing excess weight and overcoming insulin resistance, may be beneficial. Insulin resistance can lead to excessive levels of testosterone in women, leading to hirsutism. One study reported that women who remained on a low-calorie diet for at least six months lost weight and reduced insulin resistance. Their sex hormone-binding sex hormone level (SHBG) increases, which reduces the amount of free testosterone in their blood. As expected, the women reported a decrease in the severity of their hirsutism and acne symptoms.
See also
- Ferriman-Gallwey Score
- Peter Gonsalvus
- androgenic hair
- Pubic hair
- Hypertrichosis
- Hair removal
- Laser hair removal
- Bearded lady
- Trichophilia
- Polycystic ovary syndrome (PCOS)
References
External links
- Why Lady Beard Never Laughed: Hirsutism
- Berjaya Women
Source of the article : Wikipedia
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