HIRSUTISM

Hirsutism may be broadly defined as excessive terminal hair in a woman in the androgen-sensitive areas, e.g., upper lip, cheeks, chin, breasts, and lower abdomen. Various causes include polycystic ovary syndrome, nonclassic adrenal hyperplasia, and adrenal or ovarian tumors, but many women have idiopathic hirsutism. 

• Insulin resistance has been linked to hirsutism. Patients with insulin resistance are more likely to be obese and have acanthosis nigricans as well. 
• Laboratory evaluation may include dehydroepiandrosterone sulfate (DHEAS), testosterone, and prolactin. However, these are usually normal.
• When signs of virilization are present (e.g., deep voice, clitoral hypertrophy, hair loss), the presence of a hormone-secreting tumor should be considered.

Clinical

Excessive terminal hair is seen on the upper lip, cheeks, and chin in a woman with hirsutism. The breasts, lower abdomen, and elsewhere may also be affected.

Differential Diagnosis

Causes of excessive hair in a woman:

• Idiopathic--common in certain races, e.g., Euro-Asian
• Polycystic Ovary Syndrome--typical features include menstrual irregularities, hyperandrogenism, infertility, and obesity.
• Adrenal Hyperplasia
• Adrenal or Ovarian Tumor
• Drugs e.g., cyclosporin, minoxidil

Workup

One may obtain a DHEAS, free testosterone and prolactin.

RegionalDerm

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