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Hirsutism

Hirsutism is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Presence of excessive terminal (coarse, pigmented) hair of body and face, in a male pattern
  • May be present in normal adults as an ethnic characteristic or may develop as a result of androgen excess
  • Often seen in polycystic ovarian syndrome (PCOS) which is characterized by hirsutism, acne, menstrual irregularities, and obesity
  • System(s) affected: dermatologic, endocrine, metabolic, reproductive

Epidemiology

Prevalence
5–10% of adult women

Etiology and Pathophysiology

  • Hirsutism is due to increased androgenic (male) hormones, either from increased peripheral binding (idiopathic) or increased production from the ovaries, adrenals, or body fat.
  • Exogenous medications can also cause hirsutism.

Genetics
Multifactorial

Risk Factors

  • Family history
  • Ethnicity—increased in Ashkenazi Jews and Mediterranean backgrounds
  • Anovulation
  • Obesity

General Prevention

Women with late-onset congenital adrenal hyperplasia (CAH) should be counseled that they may be carriers for the severe early-onset childhood disease.

Commonly Associated Conditions

  • PCOS: the most common cause of premenopausal hirsutism (1)
  • Insulin resistance, common
  • Prolonged amenorrhea and anovulation, common
  • Emotional distress and depression, common
  • Acne, common
  • Central obesity
  • Hypothyroidism/hyperthyroidism, rare
  • Hyperprolactinemia, rare
  • Risk for endometrial hyperplasia or carcinoma, rare
  • Virilization (rapid onset, clitoromegaly, balding, deepening voice) (2)
  • Cushing syndrome: characterized by moon facies, striae, hypertension, rare
  • Vitamin D deficiency

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Citation

Stephens, Mark B., et al., editors. "Hirsutism." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116280/all/Hirsutism.
Hirsutism. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116280/all/Hirsutism. Accessed April 24, 2019.
Hirsutism. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116280/all/Hirsutism
Hirsutism [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116280/all/Hirsutism.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hirsutism ID - 116280 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116280/all/Hirsutism PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -