Adolescent With Suspected Hirsutism

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