Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

712 Hirsutism (Dermatology)

■Suspected Cushing’s: dexamethasone suppression test

■Suspected congenital adrenal hyperplasia: test for 17-hydroxypro-

gesterone

■With galactorrhea: prolactin corticotropin stimulation

Imaging

■Rapid onset of virilization: Look for tumor

➣CT of adrenals

➣Pelvic ultrasound

■Suspected PCOS: Pelvic ultrasound

■Consultation request:Endocrine or OB/GYN as needed

differential diagnosis

■Increased skin sensitivity to androgens (ISSA) – most common

■Racial variation (ethnicity, family history)

■Congenital adrenal hyperplasia (CAH)

■Polycystic ovarian syndrome

■Ovarian/adrenal androgen-secreting tumors

■Adrenal or ovarian enzyme deficiency

➣Late-onset CAH (21-hydroxylase deficiency with elevated 17-

hydroxyprogesterone)

➣Serum testosterone of >2 ng/ml and DHEAS >7000 ng/ml sug-

gests a neoplasm.

■Cushing’s syndrome

■Acromegaly

■Elevated testosterone

➣Most commonly secondary to PCOS

■Hyperprolactinemia – adrenal or ovarian source

■Increased growth hormone

■Hypothyroidism (rare)

management

■Careful history and PE, rule out more serious causes (above)

■General measures

➣Most cases are ISSA, mild to moderate symptoms

➣Major workup not indicated

specific therapy

■Workup for gradual onset of mild to moderate hirsutism rarely influ-

ences treatment – i.e., no specific treatable underlying cause is found.

■Shave

■Wax/depilatories