Hirsutism

Hirsutism

    * Introduction
    * Symptoms and Diagnosis
    * Treatment
Hirsutism is defined as excessive growth of thick yarn hair, dark women in areas where it is minimal or absent. This male pattern of occurrence of terminal hair usually occurs in androgen stimulated areas such as face, chest and breast areola. Although the terms are used with hirsutism and hypertrichosis, hypertrichosis refers to excess hair, terminal or velus in areas that are not predominantly androgen dependent. In most cases, hirsutism is a benign condition and especially a cosmetic problem. But when it is accompanied by masculinizing signs or symptoms, when occurs after puberty, may be a manifestation of a disease as severe Background adrenal or ovarian neoplasm.
Most patients with significant hirsutism have polycystic ovary syndrome. Treatment of hirsutism in itself is only necessary if the patient is bothered by his physical appearance. The practice of temporary and permanent hair removal. Pharmacological therapies for hirsutism are selected depending on the disease of substance. Anti-androgens are administered continuously. If this event are responsible virilizing adrenal or ovarian tumors indicate tumor removal. Oral contraceptives are often the first step of treatment. Antihypertensives may have to improve hirsutism, with corticosteroids, oral hypoglycemic agents.
Pathogenesis of hirsutism Hirsutism can be caused by abnormally high levels of androgens or if hair follicles are more sensitive to the normal level of androgens. Therefore the condition is commonly seen in patients with endocrine disorders characterized by hyperandrogenism, which may be caused by abnormalities of the ovaries or adrenalelor.
Presumed physiological mechanisms underlying androgenic activity include: -Production by the ovaries or adrenal androgens -Transport by androgens in the blood-transport proteins SHBG -Modification and binding to intracellular androgen receptor. Central Overproduction of androgens, increased peripheral conversion of androgens, decreased metabolism and increased binding to each receptor are potential causes for hirsutism. Because circulating testosterone exercise its stimulatory effects on hair must be converted to a metabolite dihydrotestosterone. 5-alpha reductase enzyme that is found in the hair follicle does this transformation.
Overproduction of androgens increases follicle size, increased hair diameter and length of the anagen phase. In addition to hair quality and volume change, and result in enhanced secretion of sebum. Distribution loss in women with raised androgen is changed. Excessive hair occurs in sensitive regions and androgenic alopecia on the scalp. The severity of hirsutism does not correlate directly with the level of circulating androgens due to individual differences in sensitivity conversion to dihydrotestosterone and hair follicles. Estrogens act in opposition, slowing growth and production of fine and long hairs. Progesterone has minimal effects on hair.
Causes and risk factors for hirsutism Ovarian causes of hirsutism. Polycystic ovary syndrome is a condition that affects the level of androgens. She is sic most common cause of hirsutism and androgen excess. Virilization is minimal but hirsutism is prominent. Features include menstrual irregularities, dysmenorrhea, intolerenta glucose and hyperinsulinemia and obesity. Hyperinsulinemia stimulates the ovaries to produce androgens. Women with ovarian policistice may be another characteristic feature of androgenismului-recalcitrant acne, acanthosis nigricans, alopecia scalp.
Other ovarian conditions that cause hirsutism include: Load-luteomul, arenoblastoamele Leyding-cell tumors, hilar cell tumors Theca-cell tumors.
Hirsutism family. It is not associated with excess androgens. It is typical and natural in certain populations such as women Mediterranean and Middle Eastern ancestry.
Drug-induced hirsutism. Drugs can induce hirsutism by androgenic effects: dehidroepiandrosetrn sulfate, testosterone, danazol, anabolic steroids. Drugs such as phenytoin, minoxidil, diazoxide, cyclosporine, streptomycin, psoralen, penicillamine, high-dose corticosteroids, phenothiazines, acetazolamide, hexachlorobenzene exerts independent effects of androgens. Hirsutism is different madicamente induced hypertrichosis, in which occur fine yarn on large areas of hair trunk, arms and face androgen independent.
Adrenal causes of hirsutism. Congenital adrenal hyperplasia can cause hirsutism. These children are born with ambiguous genitalia, salt loss symptoms, and no seat. Can develop masculine characteristics. Virilizing signs and menstrual irregularities are observed only at puberty. Cushing's Syndrome is a form of adrenal hyperplasia nongenitala characterized by adrenal cortisol excess. Note especially the appearance of excess velus.
Other causes of hirsutism include: , Acromegaly, hypothyroidism -Hyperprolactinemia, porphyria -Idiopathic hirsutism.