Internal Medicine

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

714 Hirsutism (Dermatology) Hirsutism (Endocrinology)

■Majority of cases: mild to moderate severity, no treatable underlying

disorder

➣Will require treatment indefinitely

Hirsutism (Endocrinology).............................

RANDOLPH B. LINDE, MD

history & physical

History

■Excessive growth of nonscalp hair in women common; highly sub-

jective

■Hair distribution mainly genetic

■Irregular menstruation, acne, and scalp hair loss

■Etiology

➣Common:

Postmenopausal: physiologic

Adolescent or young adult

With irregular menses: polycystic ovary syndrome (PCOS),

defined as hyperandrogenism, anovulation without other

cause (5% of women)

With regular menses: idiopathic; late-onset congenital adrenal

hyperplasia (CAH), esp in some ethnic groups (Ashkenazi

Jews)

Signs & Symptoms

■Use modified Ferriman-Gallwey score of 9 body areas to assess excess

terminal hair: values from 0 to 4 for none to extensive; significant if

cumulative score >7 (upper 5% of population)

■Differentiate vellus from terminal hair:

■Vellus hair excess: ethnic (Whites with dark hair and skin, Asians,

African Americans); familial; secondary to glucocorticoids or drugs

(phenytoin, cyclosporine)

■Terminal hair excess: thicker, darker, male distribution (face, neck,

sternum, low back)

■Obesity in 50% with PCOS

■Uncommon: androgenic body habitus (pseudoacromegaly); acan-

thosis nigricans (axillary, inguinal and posterior neck skin folds)

■Rare: Cushing syndrome; hypothyroidism; acromegaly; galactorrhea