STUDY - Technical - New Dacian's Medicine
Hirsutism
(Classical / Allopathic Medicine)
Hirsutism is the
excessive growth of dark, coarse body hair in females.
Excessive androgen production stimulates hair growth on the
pubic region, axilla, chin, upper lip, cheeks, anterior neck,
sternum, linea alba, forearms, abdomen, back, and upper arms.
Altered androgen metabolism is the most common cause of
hirsutism.
With mild
hirsutism, fine and pigmented hair appears on the sides of the
face and the chin (but doesn't form a complete beard) and on
the extremities, chest, abdomen, and perineum. With moderate
hirsutism, coarse and pigmented hair appears in the same
areas. With severe hirsutism, coarse hair also covers the
whole beard area, the proximal interphalangeal joints, and the
ears and nose.
Depending on the
degree of excess androgen production, hirsutism may be
associated with acne and increased skin oiliness, increased
libido, and menstrual irregularities (including anovulation
and amenorrhea). Extremely high androgen levels cause further
virilization, including such signs as breast atrophy, loss of
female body contour, frontal balding, and deepening of the
voice.
Hirsutism may
result from endocrine abnormalities and idiopathic causes. It
may also occur during pregnancy from transient androgen
production by the placenta or corpus luteum, and during
menopause from increased androgen and decreased estrogen
production. Some patients have a strong familial
predisposition to hirsutism, which may be considered normal in
the context of their genetic background.
Recognizing signs
of virilization
Excessive androgen levels produce severe hirsutism and other marked signs of virilization.
HISTORY:
Ask the patient where on her body she first noticed excessive hair growth. Ask her how old she was and where and how quickly other hirsute areas developed.
Ask the patient if she uses hair removal techniques. If so, how often does she use it, and when did she use it last?
Obtain a menstrual history: the patient's age at menarche, the duration of her menses, the usual amount of blood flow, and the number of days between menses.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Excessive androgen levels produce severe hirsutism and other marked signs of virilization.
HISTORY:
Ask the patient where on her body she first noticed excessive hair growth. Ask her how old she was and where and how quickly other hirsute areas developed.
Ask the patient if she uses hair removal techniques. If so, how often does she use it, and when did she use it last?
Obtain a menstrual history: the patient's age at menarche, the duration of her menses, the usual amount of blood flow, and the number of days between menses.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Examine the hirsute areas. Note whether excessive hair appears on other body parts as well.
Determine if the hair is fine, pigmented, dense, or coarse.
Assess whether the patient is obese. Observe her for signs of virilization. (See Recognizing signs of virilization.)
Examine the hirsute areas. Note whether excessive hair appears on other body parts as well.
Determine if the hair is fine, pigmented, dense, or coarse.
Assess whether the patient is obese. Observe her for signs of virilization. (See Recognizing signs of virilization.)
SPECIAL
CONSIDERATIONS:
Prepare the patient for hormone studies.
Prepare the patient for hormone studies.
PEDIATRIC
POINTERS:
Childhood hirsutism can stem from congenital adrenal hyperplasia. This disorder is almost always detected at birth because affected infants have ambiguous genitalia. Rarely, a mild form becomes apparent after puberty when hirsutism, irregular bleeding or amenorrhea, and signs of virilization appear.
Hirsutism that occurs at or after puberty commonly results from polycystic ovary disease.
Childhood hirsutism can stem from congenital adrenal hyperplasia. This disorder is almost always detected at birth because affected infants have ambiguous genitalia. Rarely, a mild form becomes apparent after puberty when hirsutism, irregular bleeding or amenorrhea, and signs of virilization appear.
Hirsutism that occurs at or after puberty commonly results from polycystic ovary disease.
AGING ISSUES:
Hirsutism can occur after menopause if the peripheral conversion of estrogen is poor.
Hirsutism can occur after menopause if the peripheral conversion of estrogen is poor.
PATIENT
COUNSELING:
At the patient's request, provide information on hair removal methods, such as bleaching, tweezing, hot wax treatments, chemical depilatories, shaving, and electrolysis.
At the patient's request, provide information on hair removal methods, such as bleaching, tweezing, hot wax treatments, chemical depilatories, shaving, and electrolysis.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)