HIRSUTISM AND VIRILISM Flashcards
What is hirsutism?
Excessive hairiness in a woman in those parts in which hair growth is normally either absent or minimal. Eg beard or chest hair.
What are the features of hirsutism with virilism in women?
Excessive hair growth
Clitoral hypertrophy
Breast atrophy
Deepening of voice
Male pattern balding
What percentage of healthy women are said to have a degree of hirsutism with or without virilism?
10%
Are virilism and hirsutism independent (ie one does not necessarily come with the other)?
Hirsutism can occur without virilism, however, virilism does not tend to occur without hirsutism (apart from in neonates)
What are the causes of hirsutism?
Idiopathic
Adrenal:
Congenital adrenal hyperplasia
Cushing’s syndrome
Ovarian:
PCOS
Iatrogenic: Androgens Anabolic steroids Danazol Norethisterone Phenytoin
What are the causes of virilism with hirsutism?
Never idiopathic
Adrenal:
Congenital adrenal hyperplasia
Cushing’s syndrome
Ovarian: Tumours Arrhenoblastomas Hiler cells Pregnancy luteomas
Iatrogenic:
Androgens
Anabolic steroids
Danazol
What is the most common cause of hirsutism?
PCOS
What are the features seen on examination of a patient with PCOS?
Obesity
Acanthosis nigricans
Hirsutism
Acne
What are the features seen on examination a patient with congenital adrenal hyperplasia?
Obesity
Hirsutism/virilism
Ambiguous external genitalia in severe cases
What are the features seen on examination of a patient with Cushing’s syndrome?
Hirsutism/virilism
Central obesity
Peripheral muscle atrophy
Hypertension
Striae
What are the features seen on examination of a patient with an androgen producing tumour?
Hirsutism/virilism
Very little in terms of systemic upset
Often no masses felt
How can we treat idiopathic hirsutism?
Bleaching
Electrolysis
Psychological support
How do you treat hirsutism associated with PCOS?
Encourage weight loss
Medical treatment is a combination of Ethinyloestradiol and an anti-androgen such as cyproterone acetate
Metformin has also been shown to help with all features of PCOS, as recent evidence insulin resistance is a causative factor rather than just a complication.
