166 Hirsutism Instruction Examine this patient. Salient features History • Age of onset • Rate of progression of hirsutism • History of thinning of scalp hair, or deepening of voice • History of obesity • Drug history: corticosteroids, androgen, phenytoin, minoxidil, diazoxide, ciclosporin • Take a menstrual history: oligomenorrhoea, infertility, acne, seborrhoea or voice change suggest polycystic ovaries • Family history (familial). Examination • Excessive hair growth, particularly over the face (Fig. 166.1) and upper and lower limbs. Note: The amount and distribution of hair is an index of androgen effect. Terminal hairs on the face, around the areolae or on the lower abdomen or lower back may be normal, but hair on the upper back, shoulders and upper abdomen suggests a more marked increase in androgen production. Fig. 166.1 Hirusutism. Proceed as follows: • Tell the examiner that you would like to: • check the BP and urine for sugar • look for signs of virilization (receding hairline, muscular development, breast atrophy, clitoromegaly). • Comment on cushingoid features, if any. Diagnosis This patient has hirsutism (lesion) caused by polycystic ovarian disease (etiology) that is cosmetically unacceptable (functional status). Questions What do you understand by the term hirsutism? Hirsutism is the male pattern of hair growth in women and consists of excessive terminal hair (androgen-sensitive hair). It is abnormal, particularly on the chin, sternum, upper abdomen and upper back in women. Terminal hair may normally occur on the arms, legs, upper lips, linea alba and periareolar area in women. To be active in hair follicles, testosterone has to be converted locally to dihydrotestosterone by 5α-reductase. The sensitivity of the hair follicle to androgens is governed largely by cutaneous 5α-reductase activity. Consequently, similar androgen production profiles may produce different hair growth patterns in different women. Even in hirsute women, hair growth may have greatly variable patterns. The degree of hirsutism can be assessed by the Ferriman–Gallwey Score, which records distribution and severity of excess body hair on a scale of 1–4 for nine regions (J Clin Endocrinol Metab 1961;21:1440–7). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Anaemia Superior vena caval obstruction Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Hirsutism Full access? Get Clinical Tree
166 Hirsutism Instruction Examine this patient. Salient features History • Age of onset • Rate of progression of hirsutism • History of thinning of scalp hair, or deepening of voice • History of obesity • Drug history: corticosteroids, androgen, phenytoin, minoxidil, diazoxide, ciclosporin • Take a menstrual history: oligomenorrhoea, infertility, acne, seborrhoea or voice change suggest polycystic ovaries • Family history (familial). Examination • Excessive hair growth, particularly over the face (Fig. 166.1) and upper and lower limbs. Note: The amount and distribution of hair is an index of androgen effect. Terminal hairs on the face, around the areolae or on the lower abdomen or lower back may be normal, but hair on the upper back, shoulders and upper abdomen suggests a more marked increase in androgen production. Fig. 166.1 Hirusutism. Proceed as follows: • Tell the examiner that you would like to: • check the BP and urine for sugar • look for signs of virilization (receding hairline, muscular development, breast atrophy, clitoromegaly). • Comment on cushingoid features, if any. Diagnosis This patient has hirsutism (lesion) caused by polycystic ovarian disease (etiology) that is cosmetically unacceptable (functional status). Questions What do you understand by the term hirsutism? Hirsutism is the male pattern of hair growth in women and consists of excessive terminal hair (androgen-sensitive hair). It is abnormal, particularly on the chin, sternum, upper abdomen and upper back in women. Terminal hair may normally occur on the arms, legs, upper lips, linea alba and periareolar area in women. To be active in hair follicles, testosterone has to be converted locally to dihydrotestosterone by 5α-reductase. The sensitivity of the hair follicle to androgens is governed largely by cutaneous 5α-reductase activity. Consequently, similar androgen production profiles may produce different hair growth patterns in different women. Even in hirsute women, hair growth may have greatly variable patterns. The degree of hirsutism can be assessed by the Ferriman–Gallwey Score, which records distribution and severity of excess body hair on a scale of 1–4 for nine regions (J Clin Endocrinol Metab 1961;21:1440–7). Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Anaemia Superior vena caval obstruction Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Hirsutism Full access? Get Clinical Tree
