History
In women, hirsutism exceeding culturally normal levels can be as distressing an emotional problem as the loss of scalp hair. The onset of hirsutism can take one of several forms. For example, in women with familial hirsutism, it often appears during puberty. Hirsutism usually develops gradually in patients with PCOS and CAH. Hirsutism appears abruptly when an androgen-secreting tumor arises.
Physical Examination
A woman with hirsutism has excess terminal hair in a masculine pattern, but note that hirsutism may be difficult to evaluate in women who have blond hair.
A quantitative method of measuring hair growth, the Ferriman-Gallwey model, allows for the determination of the severity of hirsutism by assessing the extent of hair growth in 9 key anatomic sites, as follows:
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Face (particularly, moustache, beard, and temple areas; see the image below)
The patient has late-onset congenital adrenal hyperplasia. She has clinical features similar to those found in polycystic ovarian syndrome, including hirsutism, acne, obesity, diabetes, and menstrual irregularities.
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Chest
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Areolae
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Linea alba
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Upper back
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Lower back
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Buttocks
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Inner thighs
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External genitalia
Other accompanying signs and symptoms may include some of the following:
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Acanthosis nigricans
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Obesity
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Pelvic mass
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Signs or symptoms of virility
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Signs or symptoms of Cushing syndrome
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Acne
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Alopecia
Complications
Complications vary depending on the etiology of the hirsutism. Complications may result from the adverse effects of hormonal or surgical treatment.
A 2008 cohort study found a high prevalence of eating disorders such as bulimia nervosa in women with hirsutism caused by polycystic ovarian syndrome (PCOS). Furthermore, women with hirsutism had high levels of depression, anxiety, low self-esteem, and poor social adjustment. Although a causal association remains unclear, hirsutism appears to be associated with eating disorders and other severe social and psychological conditions. Therefore, physicians treating women with hirsutism should consider screening these patients for psychiatric comorbidities during the management of their care. [5]
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Idiopathic hirsutism in an elderly woman.
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The patient has late-onset congenital adrenal hyperplasia. She has clinical features similar to those found in polycystic ovarian syndrome, including hirsutism, acne, obesity, diabetes, and menstrual irregularities.
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The photograph depicts hirsutism in a young woman with polycystic ovarian syndrome. Note the acne lesions and excessive hair on her face and neck.
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The photograph depicts familial hirsutism in a Pakistani woman.
