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Adolescent With Suspected Hirsutism

Home / Clinical Resources / Referral Guidelines / Adolescent With Suspected Hirsutism

Clinical Topic

Resource Type

  • Referral Guidelines

Publication Date

June 23, 2021

Contributor

Paola Palma Sisto

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Differential diagnosis of Hirsutism:

  • Physiologic hyperandrogenism of puberty
  • Idiopathic hyperandrogenism
  • PCOS

Less commonly:

  • Congenital Adrenal Hyperplasia (CAH): late onset CAH, mild CAH, non classic/virilizing CAH
  • Androgen secreting tumors of the adrenal glands or ovaries
  • Hypothyroidism
  • Cushing’s disease
  • Severe hyperprolactinemia
  • Hypertrichosis
  • Exposure to androgenic drugs

 

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.

 

Suggested References and Additional Reading:

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Screening-and-Management-of-the-Hyperandrogenic-Adolescent?IsMobileSet=false

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