Hirsutism&virilism

Hirsutism&virilism د.سها وتوت

Hirsutism:

Is the growth of terminal hair on the body of a woman in the same pattern & sequence as that which developed in post-pubertal male.



Normal hair growth: there are 2 major types of hair

1. vellus hair: are fine , lightly pigmented & cover most of the body& produced by smaller hair follicle.
2. terminal hair are larger & pigmented& found mostly on the scalp, eye brow& eyelashes prior to puberty& after puberty are present in the axilla, pubic area & male beard.



Human hair growth occur in 3 phases:


1. anagen: the growing phase
2. catagen: hair stop growing
3. telogen: arresting phase








transformation of vellus hair to terminal hair at puberty in the axilla, pubic area& male beard area is driven by systemic androgen.
Hirsutism is the result of the change in the quality, size, degree of pigmentation& length of the hair produced by individual follicle.


Incidence:

It affect about 9% of female

Pathogenesis:

The active form of testosterone(dihydrotestoestrone) interact with dermal papilla’s androgen receptors result in increase the size of hair follicle& the type of hair produced by this follicle.
Hirsutism occur in about 60-70% of patient with PCOS.


Clinical feature:

Ferriman& Gallwey grading system is widely used.


Treatment:

1.physical methods include: a. bleaching
b.shaving
c.electrolysis
d. decrease weight in obese patient.

2.phamacological method include



a. oral contraceptive pills
b. cyproterone acetate
c. spironolactone
d. flutamide
e. finasteride.



Virilism

It is invariably due to excessive androgen stimulation which is either secreted from the adrenal cortex or from the ovary.

Clinical feature:

Are defeminizing secondary amenorrhea ,loss of subcutaneous fat, breast atrophy & positive masculine features (deepening of the voice, temporal recession of hair growth, clitoral enlargement, & abnormal hair growth).


Causes of virilism :

1. congenital adrenal hyperplasia
2. iatrogenic virilization
3. adrenal tumor
4. musculinizing ovarian tumor
5. cushing syndrome
6. acromegaly
7. rarely PCOS.





Investigations:

1.17-hydroxyprogesterone
2.serum cortisol (morning &evening)
3.dexamethasone suppression test
4.MRI of adrenal gland
5.free testosterone
6.androstenedione&dehydroepiandrosterone DHEA
7.chromosomal study.


In the adolescent,adrenal hyperplasia &xy female are the most likely disorder.

Androgen producing tumors, a history of rapidly progressive musculinization should alert the clinician to the possibility on androgen secreting tumor.

Adrenal hyperplasia ,in the most common form there is a 21-hydroxylase deficiency resulting in an increase in serum 17-hydroxyprogesterone &DHEAS.


Drugs induced: one of the most common drugs that lead o irreversible virilization is danazol.











Treatment:



The treatment will depend up on diagnosis & natural history of the condition.

Treatment may involve hypophysectomy for Cushing syndrome or acromegaly.

Removal of adrenal or ovarian tumor or corticosteroid for virilizing adrenal hyperplasia.


If serum testosterone is >5 nmol, further investigation should be undertaken.