Adolescent Female With Suspected Hirsutism

Referral Guidelines are peer reviewed guidelines developed to assist referring providers in their approach to a patient presenting with common signs or symptoms suggestive of an endocrine condition, and when to refer to Pediatric Endocrinology.

Suggestive history and physical findings:

Symptoms/signs:
• Excessive terminal hair growth in locations typically seen in adult males (face, sternum, lower abdomen, back, and thighs)
• Can be associated with other signs associated with androgen excess, such as acne and irregular periods
• History of premature adrenarche may be present

Family history:
• Family history of hirsutism and/or polycystic ovarian syndrome (PCOS) may be present

Refer to Differential Diagnosis section

Labs and/or radiology studies can include:

When to refer:

Items useful for consultation:

Patient Education Materials:

Differential diagnosis for Hirsutism:

Additional information:

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.

Treatment:

Suggested References and Additional Reading:

Authors/date revised:

Downloadable PDF File

Get Involved

Join a Special Interest Group

Join PES

Mentoring Program

Explore PES Grants & Scholarships

Learn More About PES!