Hirsutism Flashcards
A young adult woman is unable to conceive after trying to get pregnant for over six months. The woman reports having had irregular periods since the onset of menarche. The primary care provider notes that the woman is overweight, has acanthosis nigricans, and an excess hair distribution. What does the provider suspect as the most likely primary cause of these symptoms?
Cushing syndrome
Type 2 diabetes
Polycystic ovarian syndrome (PCOS)
Congenital adrenal hyperplasia
PCOS is the most likely cause of oligo- or amenorrhea, so this is the most likely cause.
Hirsutism
Hirsutism is defined as excessive terminal hair growth in a female individual. It is not excess vellus (fine, ‘peach fuzz’) hair.
Hirsutism Patho
Hirsutism results from enhanced androgen-dependent stimulation of hair follicles by either increased levels of circulating androgens or increased sensitivity to them, leading to increased terminal hair differentiation.
May be idiopathic or post-menopausal (normal androgen levels)
Polycystic Ovary Syndrome
heterogeneous syndrome, with varying contributions of excess androgens, LH, follicle-stimulating hormone (FSH), and insulin resistance
PCOS Presentation
Obesity, insulin resistance, fertility issues, cardiac issues, hirutism are classic signs
Ultrasound / Imaging shows multiple (>12) follicles in the ovaries or enlarged ovary is suggestive
HAIRAN
hyperandrogenism, insulin resistance, and acanthosis nigricans, is diagnosed with a fasting basal insulin level or an insulin level during a tolerance test
Hirsutism Treatment
Weight loss if obese
Electrolysis of follicles
Androgen blockers
Spironolactone and Finastride may help clear androgens
Hirsutism Refer
If androgen levels are elevated, refer to endocrine
Hisutism Concerns
Sensitive issue for adolescent girls
PCOS related eating disorders are common
