NOTE
Virilization is excessive male-pattern hair growth in a woman plus other masculinizing signs
such as clitoromegaly, baldness, lowering of voice, increasing muscle mass, and loss of female
body contours.Hirsutism (5–10% of adult women) is excessive male-pattern hair growth in a
woman on the upper lip, chin, chest, abdomen, back, and proximal extremities. It
involves the conversion of vellus hair (fine, nonpigmented hair) to terminal
hair (coarse, dark hair) within the hair follicle. This conversion is under the
influence of androgens.
In women, androgens are generally produced in only three body locations: the
ovaries, the adrenal glands, and within the hair follicle. The workup of hirsutism
will seek to identify which of these body locations is producing the androgens
that are responsible for the excess terminal hair.
Clinical Approach.
Lab tests will help to identify the elevated free androgens.
History. Is there a positive family history? What was the age of onset? Was
onset gradual or abrupt? Have menstrual periods been irregular or regular? Is
medication history positive for androgenic steroids?
Examination. What is body-mass index? Location of excess hair? Evidence
of virilization (frontal balding, loss of female body contour, clitoromegaly)?
Presence of adnexal masses?Dehydroepiandrosterone sulfate (DHEAS) is produced only in the adrenal