The clinical evaluation of hirsutism
Article first published online: 6 OCT 2008
© 2008 Wiley Periodicals, Inc.
Volume 21, Issue 5, pages 376–391, September/October 2008
How to Cite
Somani, N., Harrison, S. and Bergfeld, W. F. (2008), The clinical evaluation of hirsutism. Dermatologic Therapy, 21: 376–391. doi: 10.1111/j.1529-8019.2008.00219.x
- Issue published online: 6 OCT 2008
- Article first published online: 6 OCT 2008
- polycystic ovarian syndrome
ABSTRACT: Hirsutism is a disorder of excess growth of terminal hairs in androgen-dependent areas in women. Other cutaneous conditions associated with androgen excess are androgenetic alopecia, acanthosis nigricans, and acne. Hirsutism is often associated with measurably elevated androgen levels, but not in all cases. Androgens in women arise from the ovary and adrenal glands, and peripherally from skin and fat. The most common cause of hirsutism is polycystic ovarian syndrome. Patients with “idiopathic” hirsutism have normal ovulatory cycles and androgen levels. Other causes are late onset congenital adrenal hyperplasia, Cushing's syndrome, and the HAIR-AN syndrome. Pituitary, ovarian, and adrenal tumors are important, but rare causes of hirsutism. A thorough history and examination are important. Laboratory investigation is essential in women with moderate to severe, sudden onset or rapidly progressing hirsutism. Identification of the underlying etiology does not alter management, but detects patients at risk for infertility, diabetes, cardiovascular disease and endometrial carcinoma.