Differential diagnosis of Hirsutism:
- Physiologic hyperandrogenism of puberty
- Idiopathic hyperandrogenism
- Congenital Adrenal Hyperplasia (CAH): late onset CAH, mild CAH, non classic/virilizing CAH
- Androgen secreting tumors of the adrenal glands or ovaries
- Cushing’s disease
- Severe hyperprolactinemia
- Exposure to androgenic drugs
- Hirsutism affects 5–10% of reproductive-aged females
- Diagnosis of hyperandrogenism can be based on clinical symptoms or measurement of serum androgens. In females, androgens originate from three primary sources: (1) the ovarian theca, (2) the adrenal cortex, and (3) within end organs by peripheral conversion.
The American College of Obstetricians and Gynecologists makes the following recommendations and conclusions:
- Pelvic ultrasonography is not routinely indicated unless serum androgen levels or the degree of virilization is concerning for an ovarian tumor.
- Multimodal therapy is the most effective approach to the treatment of hirsutism; this includes lifestyle changes, physical hair removal, and androgen suppression or blockade with medication that slows or prevents new hair growth.
- If hormonal therapy is initiated, patients should be counseled that it may take >6 months before they see the benefits of treatment.
- Patients should be assessed at routine intervals (every 3–6 months) for adverse effects and response to treatment until their condition is stable; they then should be monitored annually.
- Monitoring serum androgens is not recommended.
Suggested References and Additional Reading: