Hirsutism

1. Hirsutism
Dr. Maha Tarafawy Mohamed

2. • To define:
– Hirsutism & Virilization
To learn
Physiology of hair growth.
Androgen production in women.
Evaluation of hirsutism.
– osynthesis
– Androgen Types
To Diagnosis, management & treat
hirsutism & Virilization
Objectives

3. Definition:
• Hirisutism is (not a diagnosis in itself) excess
terminal hair in a male pattern of distribution in
female body as a result of excess androgen and
increase skin sensitivity to androgens.
virilization:
• Frontal bolding
• Deepening of voice
• Musulinization
• clitoromegaly.

4. • villus hair
is soft, downy, and fine
• Terminal hair
is darker, coarser, and kinkier

5. • Physiology of hair growth:
During adolescence, androgens converts vellus
hairs into coarse pigmented terminal hair in
androgen dependent areas.
Different body regions respond differently to
androgens, the reason is unknown. May be:
Number of receptors.
Genetic factors as evidenced by racial hair growth

7. • Androgen production:
• Adrenal glands
• Ovaries
• Adipose tissue:
(extraglandular production of
testosterone from androstenedione).
• 1. Dehydroepiandrosterone
(DHEA)
• 2. Androstenedione

8. (DHEA)
• a weak androgen secreted principally by the
adrenal glands
generally measured as
dehydroepiandrosterone sulfate (DHEA-S)
because of its longer half- life, a more reliable
measure.

9. • Androstendione:
• a weak androgen secreted in equal
amounts by the adrenal glands and
ovaries

10. Testosterone:
A potent androgen secreted by:
•Adrenal glands
•Ovaries
•Adipose tissue from the conversion of
androstenedione

11. • dihydrotestosterone (DHT)
• an androgen more potent than testosterone
• This metabolic conversion is the result of the
local action of 5α-reductase on testosterone
• within hair follicles and genital skin
• This is the basis for constitutional hirsutism

12. • dihydrotestosterone (DHT)
• an androgen more potent than testosterone
• This metabolic conversion is the result of the
local action of 5α-reductase on testosterone
• within hair follicles and genital skin
• This is the basis for constitutional hirsutism

13. • Ovarian androgen production is regulated by
luteinizing hormone (LH)
• In conditions of sustained or increased LH
secretion, androstenedione and testosterone
increase.

14. • When androstenedione production
increases, there is a dependent increase in
extraglandular testosterone production
• In obese women:
• conversion of androstenedione to
testosterone is increased.
• increase in estrone

15. • Testosterone is the primary androgen that
causes increased hair growth,acne, and
virilization.
• bound to a carrier protein—sex hormone
binding globulin (SHBG)
• Bound testosterone is unable to attach to
testosterone receptors and is metabolically
inactive
• Only a small fraction(1%–3%) of testosterone is
unbound (free)

16. • Testosterone receptors
are scattered throughout the body
• Hair follicles
• Sebaceous glands
• Genital skin
Some individuals have increased 5α-reductase
within hair follicles, resulting in excessive local
production of DHT.

17. Excess androgen production causes:
• Ovarian:
• PCOS.
• Androgen secreating tuomers.
• Adrenal:
• CAH. (21-Hydroxylase Deficiency,11β-Hydroxylase Deficiency).
• Cushing syndrome.
• Testosterone-secreting tumors.
• Other glands:
• Acromegaly
• Sever insulin resistance.
• Idiopathic

18. • Evaluation:
• History:
• Age onset of hirstusim
• Mensturel history.
• Other evidence of hyperandrognism.
• Drug history: some progestins
POLYCYSTIC OVARY SYNDROME

19. • Oligomenorrhea or amenorrhea
• Acne,hirsutism
• Infertility
• The disorder is characterized by
• Chronic anovulation
• Excess androgen
Symptoms of PCOS:

20. Definition of PCOS: Rotterdam cr.
– Physical examination:
– Assess the extent and severity virilization
– Acanthosis nigricanths.
– Laboratory :
– FSH.
– LH.
– Testesteron, estrone.
– Laboratiry investigation for cushing syndrome
– Laboratory investigation of CAH.(17-OH progesterone, plasma
desoxycorticosterone
– Imaging for PCOS

21. Assessment of PCOS:
–Physical examination:
–Assess the extent and severity virilization
–Acanthosis nigricanths.
–Laboratory :
–FSH.
–LH.
–Testesteron, estrone.
–Laboratiry investigation for cushing syndrome
–Laboratory investigation of CAH.(17-OH progesterone,
plasma desoxycorticosterone
–Imaging for PCOS