2-Hypertrichosis:- Hypertrichosis is the

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Cora Hudson
5 years ago
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1 Hirsutism And Virilization

2 Hirsutism:- Is the development of androgen-dependent dependent terminal body hair in a woman in places in which terminal hair is normally not found, terminal body hairs are the stiff, pigmented hairs normally seen in men on the face, chest, abdomen, and back, which are not normal in women. Hirsutism affect between 5 and 10 per cent of women of reproductive age.

3 Virilization :- Refers to the state in which androgen levels are sufficiently high to cause not only hirsutism, but additional signs and symptoms such as deepening of the voice, breast atrophy, increased muscle bulk, and clitoromegaly.

4 There are two conditions characterized by generalized hair growth that do not represent true hirsutism:- 1-Androgen Androgen-independent hair:- which is the soft vellus unpigmented hair that covers the entire body. In infants, this hair is called lanugo..

5 2-Hypertrichosis:- Hypertrichosis is the term used to describe the excessive growth of androgen-independent hair which is vellus, prominent in non-sexual areas, and most commonly familial or caused by systemic disorders (hypothyroidism, anorexia nervosa, malnutrition, porphyria, and dermatomyositis), or medications(phenytoin, penicillamine, diazoxide, minoxidil, or cyclosporine) or as a paraneoplastic syndrome in some patients with cancer.

6 Causes of hirsutism

7 Common 1-Idiopathic hirsutism. 2-Polycystic ovary syndrome.

8 Uncommon 1-Drug: Drug:- Danazol, Oral contraceptives containing androgenic progestins. 2-Congenital adrenal hyperplasia (most often 21- hydroxylase deficiency(. 3-Hyperthecosis. 4-Ovarian tumors:- Sertoli-Leydig cell tumors. Granulosa-theca cell tumors. Hilus-cell tumors. 5-Adrenal tumors. 6-Severe insulin resistance syndromes. 7-Hyperprolactinemia. 8-Cushing's syndrome.

9 Hyperthecosis refers to the presence of nests of luteinized theca cells in the ovarian stroma due to differentiation of the ovarian interstitial cells into steroidogenically active luteinized stromal cells. These nests or islands of luteinized theca cells are scattered throughout the stroma of the ovary, rather than being confined to areas around cystic follicles as in the polycystic ovary syndrome

10 Basic Approach to the patient

11 History:- Menstrual history. Hyperandrogenic symptoms. Weight history. Medication history. Family history.

12 Physical examination :- The physical examination provides information about the extent of hirsutism and sometimes about its cause.

13 Ferriman-Gallwey score

14 Investigations:- A-Laboratory Testing :- 1-Serum androgens :- They are sufficient to exclude androgen-secreting tumors in most women; specifically, values below (5.2 nmol/l) exclude ovarian or adrenal tumors These values also tend to exclude ovarian hyperthecosis. Most women with PCOS have serum testosterone concentrations below (5.2 nmol/l), and sometimes normal; women with idiopathic hirsutism are even more likely to have normal values.

15 Moderately elevated (or higher) serum androgen concentrations, eg, serum total testosterone values above (5.2 nmol/l) serum free testosterone values above ( nmol/l) ; and serum dehydroepiandrosterone sulfate (DHEA-S) values above (13.6 µmol/l) in young women raise the possibility of an androgen-secreting tumors.

16 2-Serum prolactin. 3-Serum luteinizing hormone (LH)) :- Women with PCOS tend to have elevated serum LH concentrations and normal or low serum FSH concentrations. 4-OH progesterone :-congenital adrenal hyperplasia, or to know a specific etiologic diagnosis. 5-Testing for Cushing's syndrome.

17 B-Radiological Testing :- 1-Pelvic ultrasonography 2-Abdominal CT or MRI Testing:- C-Laparoscopy or laparotomy D-Ovarian and adrenal vein sampling :- E-GnRH agonist testing :- GnRH agonist testing has been utilized as a means of making a specific diagnosis of ovarian hyperandrogenism.

18 Preoperative Treatment preparation:- of hirsutism

19 Nonpharmacologic Therapy:- 1-Hair removal :- Shaving, Chemical depilatories and bleaching,and wax are all easy and cheep. Electrolysis is safe and effective but expensive. Laser treatment, although expensive, is effective and can often result in permanent reduction in hair growth.

20 Pharmacologic Therapy:- 1- Eflornithine hydrochloride cream :- is a topical drug,is an inhibitor of hair growth, not a depilatory, and must be used indefinitely to prevent regrowth. 2-Hormonal therapy:-oral contraceptives

21 . 3-Antiandrogen therapy A-Spironolactone :- The usual dose is mg given once daily. The benefit was noticeable within two months, reached a peak at six months, and was maintained at 12 months.

22 B-Flutamide :- Flutamide, also inhibits testosterone binding to its receptors, dose :- (250 mg BID). C-Finasteride :- Finasteride inhibits 5-alpha- reductase, the enzyme that catalyzes the conversion of testosterone to dihydrotestosterone.compared with spironolactone, finasteride is as or less effective.finasteride lowers hirsutism scores better when given in combination with an oral contraceptive. Dose of finasteride (5 mg/day).

23 D-Cyproterone acetate:- E-ketoconazole :- Is Antifungal Agent, it act on steriodogenic cytocrom enzyme in the liver,and decrease androstenedione and free testosterone level, if give at a dose of (200 mg/day). Side effect are dry skin, scalp hair loss, and hepatotoxic in largev doses ( mg/day).

24 Other therapies:- 1-Gonadotropin-releasing releasing hormone agonist :- 2-Insulin-lowering lowering agents :- Both metformin and rosiglitazone can be modestly effective in the treatment of hirsutism associated with PCOS. Both agents can restore ovulatory cycles and reduce circulating testosterone and androstenedione in some women with PCOS.

Case. 24 year old female presented to your office complaining of excess hair growth on her face and abdomen. Questions?

Case. 24 year old female presented to your office complaining of excess hair growth on her face and abdomen. Questions? Hirsutism Case 24 year old female presented to your office complaining of excess hair growth on her face and abdomen Questions? Started around puberty with gradual progression Irregular menstrual cycle