Hirsutism

1. HIRSUTISM

2. Introduction
 Hirsutisme is defined as the presence of terminal
coarse hair in a female in the androgen dependent
area in a male-like pattern
 Hypertrichosis is defferent with hirsutism

3. Normal Growth and Development
Lanugo
Vellus
Terminal

4. Regulatory Factor In Hair Growth
 Local and Sytemic Factor
 Sex Steroids
anagen
• It is an active ongoing phase
catagen
• An involutional stage in which the hair ceases to grow
Telogen
• This is a resting phase where the hair is resting then falls out as
the new hairs tkes its place

5. Diagnosis Of Hirsutism
 Modified Ferriman-Galleway Score
 If score >6 defines as hirsutism (total score ranges from
0-36)
 Score 0 : if terminal hair growth is not seen in the
above arreas
 Score 1 : if terminal hair growth is not seen in the
above arreas
 Score 2 : if hair growth is more than minimal but not
equivalent to that of an adult male
 Score 3 : if hair growth is that not a very hairy male
 Score 4 : observed in well-virilized healthy males
 Grade
 Mild : up to 15
 Moderate : 16 to 25
 Severe : > 25

6. Etiology
Idiopatic
Drug induced
Miscellaneous
Adrenal
Ovarian

7. Investigation and Management
 History and Examination
 Modified F-G Score
 Hormonal Evaluation
 Metabolic Profile
 Ultrasound evaluation
Table 2. Hormonal evaluation of hirsutism
Androgen Normal value in female
Total Testosteron 20-80 ng/dL
Free Testosteron 0.3-1.9 ng/dL
Bioavabilitas testosterone 0.8-10 ng/dL
Free Androgen Index (T/SHBG x 100) 0.7-1
Androgen-producing tumor >200 ng/dL
(T: testosterone: SHBG: sex hormone-binding globulin)

8. Treatment
Hair removal
measures
Pharmacotherapy
Lifestyle
modifications

9. Table 4. Drug Therapy Of Hirsutism
Type of drugs Drug Dose Side Effect Comments
Androgen
reseptor-bloker
Spironolactone 100-200 mg/day Hierpkalemia, mild
diuretic effect,
hypotension, and
irregular menses
Because of the dangers of antiandrogenic effect on
fetal genital development, it is recommended that an
effective contraceptive method should be used
whenever spironolactone is prescribed
Cyproterone
asetat
2 mg with 35 ug
ethinylestradiol as
contraceptive pil
Nausea, fatigue,
mastalgia, loss of
libido, weight gain
should be given with ethinylestradiol to prevent
menstrual irregularities and ovulation
Flutamid 250-750 mg/day Liver toxicity It is not approved for the threatment of hirsutism by
the endocrine society because of the risk of liver failure
5a-reductase
inhibitor
Finasteride 5-7.5 mg/day Gastrointestinal
disturbance,
headache, dry skin,
and decreased libido

10.  Topical Eflornithine
 Insulin sensitizer
 Miscellaneous Agent
 GnRH Analog (Leuprolid Depot 3,75 mg/month)
 Glucocoticoids (prednisolone 5-10 mg/day
 Ketokonazole 400 mg/day

11. Follow up
 6 months treatment is required
 If inadequate response after 6 months, change the agents or using
combination therapy
 Measuring the androgen level is not convincing the result of therapy

12. THANK YOU