hirsuitism

Question 1

what are the stages of hair follicles life cycle?

Answer 1

• anagen: active phase of growth of hair
• catogen: involution of epithelial cells surrounding dermal papilla
• telogen: resting phase (hair falls out with initiation of anagen)

ACT

Question 2

ddx for hirsuitism

Answer 2

• familial
• PCOS
• CAH
• adrenal or ovarian tumor
• drugs (danazol, androgens)

Question 3

work-up for hirsuitism?

Answer 3

• total testosterone
• free testosterone
• DHEA-S
• 17 OHP (> 800 suspicion for CAH, > 1200 diagnostic for CAH)
• assess for PCOS (if not normal cycles)

Question 4

treatment for idiopathic hirsuitism?

Answer 4

• OCPS (esp including drospirenone): increase SHBG
• finasteride (5 alpha reductase inhibitors)
• spironolactone - blocks androgen receptor and inhibits 5 alpha reductase. also decreases androgen production
• flutamide: blocks androgen receptor
• vainiqua: blocks ornithine carboxylase
• cyproterone: potent progestin/anti-androgen
• laser hair removal