Hirsutism is excessive growth of hair on the body and face in women according to the male (androgenic) type. It is characterized by the appearance of hair in the upper lip, chin, chest, back and abdomen. With hirsutism, there is often a violation of the regularity of the menstrual cycle, uterine bleeding, infertility, anemia. A mild degree may not require therapeutic measures. Disease of a pronounced degree requires long-term treatment (from 6 to 12 months) and elimination of the cause (polycystic or ovarian tumors, adrenal tumors, pituitary gland, Cushing syndrome) to stop hair growth. To get rid of the hair present in the undesirable zone, patients are helped by various cosmetic methods.
ICD 10
L68.0 Hirsutism
Meaning
Hirsutism is excessive growth of hair on the body and face in women according to the male (androgenic) type. It is characterized by the appearance of hair in the upper lip, chin, chest, back and abdomen. With hirsutism, there is often a violation of the regularity of the menstrual cycle, uterine bleeding, infertility, anemia. It requires long-term treatment (from 6 to 12 months) and elimination of the cause (polycystic or ovarian tumors, adrenal tumors, pituitary gland, Itsenko-Cushing syndrome) to stop hair growth.
Pathology is observed in approximately 2-10% of women and can be so pronounced that it forces a woman to resort to various methods of mechanical removal of excess hair. With hirsutism, there is an increase in coarse, pigmented core hair in androgen-dependent areas with increased sensitivity to male sex hormones – androgens: on the face, chest, around the areola of the nipple, on the abdomen, back, hips. Hirsutism is not only a cosmetological problem, but also evidence of the presence of serious pathological processes in the body that require correction by a gynecologist and endocrinologist.
Disease should be distinguished from hypertrichosis, in which hair growth occurs in androgen-independent zones.
Causes
With hirsutism, thin, soft, unpigmented fluffy hair under the influence of a number of factors is transformed into terminal – long, hard and pigmented. Among the causes of hirsutism, hyperandrogenism, family factor, side effects of medications and idiopathic excess of androgens are most common.
Hyperandrogenism, or increased production of androgens (male sex hormones), can develop in the following conditions:
- disorders of ovarian function in polycystic ovary syndrome, ovarian neoplasms, ovarian hyperthecosis, chronic anovulation, hypothalamic amenorrhea, etc. Hirsutism of ovarian origin is characterized by menstrual disorders, infertility, ovarian hypertrophy.
- disorders of adrenal function in congenital or acquired hyperplasia of the adrenal cortex, adrenal tumors, etc. Hirsutism of adrenal genesis develops due to increased production of steroid hormones by the adrenal glands, including androgens.
- disorders of pituitary function in Cushing’s syndrome, acromegaly, prolactinoma, etc. Hirsutism of pituitary origin is caused by primary pituitary lesion with further involvement of the adrenal glands and is characterized by increased secretion of cortisol and androgens.
The development of familial (or genetic) hirsutism occurs as a result of genetic and chromosomal features observed over several generations in individual families or ethnic groups.
Taking a number of medications has a side effect of the development of hirsutism. These are corticosteroids (hydrocortisone, cortisol, etc.), anabolic drugs, progestins, androgens, streptomycin, acetazolamide, interferon, cyclosporine, carbamazepine, etc.
Hirsutism caused by unknown causes is called idiopathic androgen excess syndrome. In idiopathic hirsutism, there is an increased sensitivity to androgen receptors of the skin and hair follicles. Manifestations of idiopathic hirsutism are less pronounced, hormonal abnormalities are insignificant, the menstrual cycle and reproductive function are usually not impaired.
The causes of disease can also be the physiological and age-related conditions of a woman, during which there is a shift in the ratio of estrogens and androgens (pregnancy, postmenopause). In 90% of cases, hirsutism is caused by polycystic ovary syndrome or idiopathic syndrome.
Classification
In accordance with the causes of excessive hair loss, several clinical forms are distinguished in endocrinology:
- neuroendocrine: ovarian, adrenal, pituitary hirsutism;
- dermatological or constitutional: familial, idiopathic hirsutism;
- iatrogenic or exogenous – drug-dependent hirsutism.
According to the degree of association of hirsutism with other disorders, there are:
- hirsutism itself;
- burdened with hyperactive piloseborrheic complex (acne, acne, etc.);
- with ovulation disorders;
- in combination with signs of virilization.
Hirsutism symptoms
The main manifestation of hirsutism is the male type of hair loss in women, i.e. the growth of short, hard, pigmented hair on the face, chest, around the areoles of the mammary glands, on the back, abdomen, inner surfaces of the thighs, buttocks. Other signs of hirsutism are increased greasiness of the skin and hair, acne, alopecia, as a consequence of an increased level of androgens. Hirsutism is often accompanied by a disorder of menstrual function (irregular menstruation, amenorrhea) and infertility.
In the future, with hirsutism caused by hyperandrogenism in women, signs of virilization often develop, that is, male traits: muscle mass increases, the voice becomes rougher, baldness appears on the temples, sexual desire increases, the size of the mammary glands decreases, the localization of fat deposits on the body changes according to the male type. Hyperandrogenism causes changes on the part of the female genital organs: the clitoris increases, the labia decreases, the formation of vaginal lubrication stops.
To assess the severity of hirsutism manifestations, various quantitative indicator systems are used. The degree of facial hair is estimated on a scale from “0” to “+4”, where “+1” is the presence of hair above the upper lip or on the chin, and “+4” is a well–developed beard. According to another counting scale , the severity of hirsutism is determined by counting:
- “hormonal number” (the sum of points characterizing the quantitative and qualitative growth of hair on the chin, upper lip, chest and mammary glands, upper and lower back, upper and lower half of the abdomen, shoulders and hips);
- “indifferent number” (the sum of points characterizing the quantitative and qualitative growth of hair on the forearm and lower leg);
- the “hirsute number” (the sum of the “indifferent” and “hormonal” numbers at the norm is less than 12 points, on average 4.5-4.6 points).
However, these estimates are largely subjective and are important only for assessing the dynamics of increasing or decreasing hair growth during treatment or with the progression of the disease.
Complications
The course can be complicated by menstrual disorders, infertility, pathological uterine bleeding, anemia. Hirsutism on the background of polycystic ovaries is often combined with diabetes mellitus.
Diagnostics
When collecting anamnesis in patients with hirsutism, it is necessary to find out the following factors:
1. The nature of the development of the disease:
- gradual growth of body hair, accompanied by the appearance of acne, weight gain, irregular menstruation, more often testifies in favor of polycystic ovaries.
- a sharp development of hirsutism, accompanied by signs of virilization, is more often observed in androgen-secreting tumors.
2. Medical history.
3. The nature of menstrual function. In patients with a regular menstrual cycle, hirsutism is usually idiopathic or familial in nature and does not require in-depth examination.
To find out the nature of hirsutism, laboratory tests are carried out, determining the content of the following hormones in the blood serum:
- total testosterone (with a testosterone content of 200 ng% – tumor lesion of the ovaries);
- dehydroepiandrosterone sulfate (DEA-C) is an indicator of the activity of the secretory function of the adrenal glands (at a concentration of DEA-C > 700 ng%, decreasing when taking dexamethasone, adrenal hyperplasia is suspected; an increased level of DEA-C makes one think of tumor processes in the adrenal glands);
- androstenedione (an increase in the concentration of androstenedione is observed in ovarian pathology);
- 17-hydroxyprogesterone – an intermediate metabolite of steroid hormones of the adrenal glands (increases with congenital forms of adrenal hyperplasia);
- cortisol (concentration increases with Itsenko-Cushing syndrome);
- gonadotropins (the concentration of LH increases in relation to FSH in polycystic ovaries).
To find out the causes of hirsutism, a gynecologist is consulted, ultrasound of the adrenal glands and ovaries, CT, MRI of the adrenal glands and other organs, MRI of the brain. Diagnostic laparoscopy is performed to exclude tumor processes in the ovaries.
Hirsutism treatment
A mild degree of hirsutism, not accompanied by a violation of menstrual function, does not require special treatment. Since hirsutism, as a rule, is not an independent disease, but a manifestation of another pathology, its treatment is aimed at eliminating the primary etiological factor (removal of tumors of the adrenal glands, pituitary gland or ovaries, cancellation of medications that cause hair growth, treatment of hypothyroidism, Itsenko—Cushing syndrome or acromegaly, etc.).
Drug therapy for hirsutism is prescribed after the exclusion of androgen-secreting tumors. Since hirsutism is most often a consequence of hyperandrogenism, it is advisable to prescribe antiandrogenic drugs that suppress testosterone levels and reduce sensitivity to androgens of hair follicles.
With congenital adrenal hyperplasia, cortisol, prednisone or dexamethasone is used. To suppress the excessive formation of androgens in polycystic ovaries, oral contraceptives, spironlactone, clomiphene are prescribed. The cycle of treatment with hormonal drugs takes from 3 to 6 months, sometimes cycles have to be carried out repeatedly. It should be taken into account the presence of serious contraindications to antiandrogen treatment during pregnancy, as well as the fact that taking these drugs prevents the appearance of new hair, but does not reduce existing ones. With hirsutism, accompanied by overweight, patients are recommended to follow a diet with a reduced carbohydrate content.
Cosmetic treatments for hirsutism help to remove or make less noticeable unwanted hair. They include lightening, plucking, shaving, bioepilation with wax or special creams, epilation, etc. Moderate manifestations of hirsutism are masked by discoloration of the hair with hydrogen peroxide. Constant plucking and shaving of hair can cause scarring or skin infections. Chemical depilation is ineffective against thick and coarse hair. The most effective method of getting rid of hair in hirsutism is photoepilation or laser hair removal, which destroys the hair follicle and stops the growth of new hair.
Forecast
Many women suffering from hirsutism develop serious psychological complexes that interfere with a full-fledged family and intimate life, making it difficult to communicate in society.
Treatment of hirsutism is long-term, the effect of reducing hair growth becomes noticeable only after 6-12 months. In the treatment of hirsutism, the growth of new hair is suspended, but the existing hair does not disappear. Therefore, it is not possible to completely get rid of excessive hair growth with hirsutism, although it is quite possible to slow down the rate of their growth.
