A COMPREHENSIVE GUIDE TO DIAGNOSIS AND MANAGEMENT OF HIRSUTISM

Hirsutism is a medical condition characterized by excessive hair growth in women, often on the face, chest, back, and other areas where men typically grow hair. It can be caused by a variety of factors, including:

1. Polycystic ovary syndrome (PCOS): PCOS is a common endocrine disorder that affects 5-10% of women of childbearing age. It is characterized by irregular menstrual cycles, cysts on the ovaries, and high levels of androgens (male hormones). Hirsutism is a common symptom of PCOS.

2. Congenital adrenal hyperplasia (CAH): CAH is a rare genetic disorder that affects the production of hormones by the adrenal glands. One form of CAH, known as classic CAH, can cause hirsutism due to excessive production of androgens.

3. Androgen insensitivity syndrome (AIS): AIS is a rare genetic disorder that affects the body’s ability to respond to androgens. Women with AIS may experience hirsutism due to increased levels of androgens.

4. Thyroid disorders: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can cause hirsutism due to changes in hormone levels.

5. Obesity: Excess weight can lead to increased production of androgens, which can cause hirsutism.

6. Drug use: Certain medications, such as anabolic steroids and certain antidepressants, can cause hirsutism as a side effect.

7. Genetics: Hirsutism can run in families, suggesting that there may be a genetic component to the condition.

8. Other medical conditions: Certain medical conditions, such as Cushing’s syndrome and Turner syndrome, can also cause hirsutism.

It is important to note that hirsutism can have a significant impact on a woman’s quality of life, causing emotional distress and social stigma. If you are experiencing excessive hair growth, it is important to speak with a healthcare provider to determine the underlying cause and develop an appropriate treatment plan.

 

Investigations for Hirsutism

When evaluating a patient with hirsutism, several investigations are commonly performed to determine the cause. These investigations include:

1. Medical History and Physical Examination: The first step in investigating hirsutism involves taking a detailed medical history and performing a thorough physical examination. The healthcare provider will ask about the onset and progression of excessive hair growth, any associated symptoms, menstrual irregularities, family history of similar conditions, and medication use. A physical examination will assess the distribution and severity of hair growth and may also include an assessment of other signs of hormonal imbalance such as acne or male pattern baldness.

2. Hormonal Evaluation: Hormonal evaluation plays a crucial role in identifying the underlying cause of hirsutism. This typically involves measuring hormone levels in the blood. The hormones commonly assessed include:

• Testosterone: Elevated levels of testosterone can contribute to hirsutism. Total testosterone levels are measured initially, followed by free testosterone levels if the total testosterone is found to be elevated.
• Dehydroepiandrosterone sulfate (DHEAS): DHEAS is another hormone that can contribute to excessive hair growth. Elevated levels may indicate adrenal gland dysfunction.
• Sex Hormone-Binding Globulin (SHBG): SHBG binds to testosterone in the blood, reducing its availability for action. Low levels of SHBG can result in increased free testosterone levels.
• Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): These hormones are involved in regulating ovarian function. Imbalances in FSH and LH levels can indicate polycystic ovary syndrome (PCOS) or other ovarian disorders.
• Prolactin: Elevated levels of prolactin can contribute to hirsutism. High levels may indicate a pituitary gland disorder.
• Thyroid-Stimulating Hormone (TSH): Thyroid dysfunction can cause hirsutism. TSH levels are measured to assess thyroid function.

3. Imaging Studies: In some cases, imaging studies may be required to evaluate the underlying cause of hirsutism. These studies can help identify structural abnormalities or tumors that may be contributing to excessive hair growth. The specific imaging modality used depends on the suspected cause and may include:

• Pelvic Ultrasound: This non-invasive imaging technique is commonly used to assess the ovaries for cysts or other abnormalities in patients with suspected PCOS.
• Adrenal Gland Imaging: Imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be performed to evaluate the adrenal glands for tumors or other abnormalities.
• Pituitary Gland Imaging: If a pituitary disorder is suspected, an MRI of the brain may be ordered to assess the pituitary gland for tumors or other abnormalities.

4. Additional Investigations: Depending on the findings from the initial investigations, additional tests may be required to further evaluate the underlying cause of hirsutism. These tests may include:

• Glucose Tolerance Test: This test is performed to assess insulin resistance and glucose metabolism, which are commonly associated with PCOS.
• 17-hydroxyprogesterone (17-OHP) Test: Elevated levels of 17-OHP may indicate congenital adrenal hyperplasia, a genetic disorder that affects adrenal gland function.
• Androgen Receptor Gene Analysis: In rare cases, genetic testing may be performed to identify mutations in the androgen receptor gene, which can cause hirsutism.

It is important to note that the specific investigations performed may vary depending on the individual patient and the suspected underlying cause of hirsutism. A thorough evaluation by a healthcare professional is necessary to determine the most appropriate investigations for each case.

 

Management of Hirsutism

Management and treatment options are available to help alleviate the symptoms of hirsutism.

1. Lifestyle Modifications: In some cases, lifestyle modifications can help manage hirsutism. These include weight loss (if overweight or obese), regular exercise, and a healthy diet. Maintaining a healthy weight can help regulate hormone levels and reduce the severity of hirsutism symptoms.

2. Hair Removal Techniques: Various hair removal techniques can be used to manage hirsutism. These include:

• Shaving: Shaving is a simple and inexpensive method to remove unwanted hair temporarily. However, it needs to be done frequently as hair regrowth occurs quickly.
• Waxing: Waxing involves applying hot or cold wax to the skin and then removing it along with the hair. This method provides longer-lasting results compared to shaving but can be painful.
• Depilatory Creams: Depilatory creams contain chemicals that dissolve the hair at the skin’s surface. They are easy to use but may cause skin irritation in some individuals.
• Bleaching: Bleaching lightens the color of the hair, making it less noticeable. This method does not remove the hair but can be an option for those who prefer not to remove it completely.
• Electrolysis: Electrolysis involves inserting a tiny needle into each hair follicle and delivering an electric current to destroy the follicle. It is a permanent hair removal method but can be time-consuming and expensive.
• Laser Hair Removal: Laser hair removal uses laser technology to target and destroy hair follicles. It provides long-term reduction in hair growth, but multiple sessions are usually required for optimal results.

3. Medications: Medications may be prescribed to manage hirsutism, especially when it is caused by hormonal imbalances. These medications include:

• Oral Contraceptives: Combination birth control pills containing estrogen and progestin can help regulate hormone levels and reduce excessive hair growth.
• Anti-Androgens: Anti-androgen medications block the effects of androgens on the body, reducing hair growth. Spironolactone and flutamide are commonly used anti-androgens.
• Topical Creams: Eflornithine cream is a prescription medication that can slow down the growth of facial hair in women. It does not remove existing hair but can help manage excessive growth.

4. Hormonal Therapy: In cases where hirsutism is caused by underlying hormonal conditions such as polycystic ovary syndrome (PCOS), hormonal therapy may be recommended. This involves using medications like metformin or clomiphene citrate to regulate hormone levels and improve symptoms.

5. Surgery: In rare cases where hirsutism is severe and resistant to other treatments, surgical options may be considered. Ovarian drilling is a minimally invasive procedure that involves using heat or laser to destroy a portion of the ovaries, reducing androgen production.

It is important to note that the management and treatment of hirsutism should be personalized based on the underlying cause, severity of symptoms, and individual preferences. Consulting with a healthcare professional, such as a dermatologist or endocrinologist, is crucial for accurate diagnosis and appropriate treatment planning.