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 ovary syndrome (PCOS), which is characterized by hirsutism, acne, menstrual irregularities, and obesity
• System(s) affected: dermatologic, endocrine, metabolic, reproductive

Epidemiology

Prevalence
5–10% of reproductive age women

Etiology and Pathophysiology

• 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 be a symptom of multiple etiologies such as clinical evidence of PCOS, androgen secreting tumors, virilizing disorders, or androgenic medication use

Genetics
Multifactorial

Risk Factors

• Family history/ethnicity (e.g., Ashkenazi Jews and Mediterranean backgrounds)
• 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
• Acromegaly, rare
• Vitamin D deficiency