Hirsutism

At the first visit, establish age at onset, duration, rate of change, menstrual frequency, acne, female-pattern hair loss, and symptoms or signs of virilization. Assess BMI and blood pressure, and document whether symptoms are distressing enough to warrant treatment. Early-onset, slowly progressive mild androgen-excess features are more compatible with PCOS; late-onset or rapidly progressive virilizing symptoms are more concerning for an androgen-producing tumor. Wolters Kluwer+1Wolters KluwerScreening and Management of the Hyperandrogenic AdolescentWileySociety for Endocrinology Clinical Practice Guideline for the ...

Actively look for syndrome-specific clues that redirect testing: Cushing syndrome features, severe insulin resistance, genital ambiguity, and findings of congenital adrenal hyperplasia. Genital ambiguity points toward virilizing forms of congenital adrenal hyperplasia; classic CAH may also present with hirsutism when glucocorticoid replacement is inadequate. Wiley+2WileySociety for Endocrinology Clinical Practice Guideline for the ...Oxford AcademicApproach to the Patient with Hirsutism - Oxford AcademicOxford AcademicEpidemiology, diagnosis and management of hirsutism: a ...

If neoplastic androgen excess is suspected on the basis of rapid progression, virilization, or concerning clinical context, make an urgent referral to a center with relevant endocrine and gynecologic expertise. Do not delay escalation by assuming PCOS solely because hirsutism and menstrual irregularity coexist. Wiley+1WileySociety for Endocrinology Clinical Practice Guideline for the ...Wolters KluwerPrevalence of Congenital Adrenal Hyperplasia in... : Indian Journal of Endocrinology and Metabolism

Use the clinical examination and modified Ferriman-Gallwey score to determine testing intensity. In isolated hair growth or a low modified Ferriman-Gallwey score, biochemical testing is usually unnecessary. For the common mild presentation without red flags, measure testosterone and SHBG and calculate the free androgen index using the local laboratory reference range; there is no universally accepted normal free androgen index cutoff. BMJBMJFifteen-minute consultation: Approach to the adolescent presenting with hirsutism | ADC Education & Practice Edition

In adolescents with clinical hyperandrogenism, guidelines commonly include total testosterone, free testosterone, or both. A total or free testosterone concentration above adult female normative values supports biochemical hyperandrogenism; interpretation must use the reporting laboratory's adult female reference interval. Wolters KluwerWolters KluwerScreening and Management of the Hyperandrogenic Adolescent

Use a broader androgen panel—17-hydroxyprogesterone, androstenedione, DHEAS, and testosterone—when red flags suggest marked androgen excess, an adrenal process, or another endocrinopathy. This approach is more appropriate than pelvic ultrasonography as the initial universal test for an adolescent presenting with hirsutism. BMJ+1BMJFifteen-minute consultation: Approach to the adolescent presenting with hirsutism | ADC Education & Practice EditionBMJApproach to the adolescent presenting with hirsutism

PCOS is the most common hyperandrogenic disorder associated with hirsutism. A pattern of hirsutism with acne, androgenic alopecia, and menstrual irregularity supports hyperandrogenism, but secondary causes relevant to a PCOS-like presentation include hypothyroidism, hyperprolactinemia, nonclassic congenital adrenal hyperplasia, adrenal or ovarian neoplasms, Cushing syndrome, and acromegaly. Oxford Academic+2Oxford AcademicEvaluation and Treatment of Hirsutism in Premenopausal ...Wolters KluwerPrevalence of Congenital Adrenal Hyperplasia in... : Indian Journal of Endocrinology and MetabolismWileyApproach to androgen excess in women: Clinical and biochemical ...

Nonclassic congenital adrenal hyperplasia should be considered particularly when symptoms are insidious from puberty and 17-hydroxyprogesterone is elevated. Basal morning follicular-phase 17-hydroxyprogesterone greater than 5 l/L warrants stimulation testing; a stimulated concentration greater than 30 l/L is diagnostic in the cited clinical guideline. WileyWileySociety for Endocrinology Clinical Practice Guideline for the ...

Androgen-secreting tumors are uncommon but clinically consequential. Older age, late onset, rapid progression, and virilization are the most useful bedside triggers for urgent specialty assessment. In postmenopausal patients, androgen excess may originate in the ovary or adrenal gland, so the diagnostic strategy should not presume a single source. Wiley+2WileySociety for Endocrinology Clinical Practice Guideline for the ...Oxford AcademicAndrogen-Secreting Adrenal Adenoma in a Postmenopausal ...Oxford AcademicApproach to Investigation of Hyperandrogenism in a ...

Determine whether treatment is wanted before prescribing medication: in adolescents with hyperandrogenic symptoms, therapy is indicated when acne or hirsutism is distressing to the patient. Pair medical treatment with a hair-removal method selected by the patient, including electrolysis or laser hair removal; eflornithine hydrochloride 13.9% topical cream may help reduce unwanted facial hair. Wolters Kluwer+1Wolters KluwerScreening and Management of the Hyperandrogenic AdolescentCochraneInterventions for hirsutism (excluding laser and photoepilation therapy alone) - van Zuuren, EJ - 2015 | Cochrane Library

Oral contraceptive therapy is a longstanding hormonal-suppression option for menstrual irregularity and hirsutism in PCOS, acting in part through suppression of ovarian androgen production. For more severe hirsutism, spironolactone can be added to oral-contraceptive therapy, with closer monitoring for adverse effects than with other options. Wiley+2WileyClinical management of PCOS - Tan - Obstetrics and GynecologyWileyThe long term health consequences of polycystic ovary syndromeCochraneInterventions for hirsutism (excluding laser and photoepilation therapy alone) - van Zuuren, EJ - 2015 | Cochrane Library

Antiandrogens are effective for hirsutism, but selection requires attention to pregnancy risk and contraindications. Spironolactone 100 mg/day has been reported to be more effective than finasteride 5 mg/day for hyperandrogenic hirsutism. Spironolactone is contraindicated in pregnancy, and potassium monitoring is particularly relevant in patients with kidney disease or excessive potassium intake. Wiley+2WileyMedical treatment of hirsutism - Blume‐Peytavi - 2008cdn clinicaltrials[PDF] Metabolic and Neuro-Endocrine Effect of ... - ClinicalTrials.govOxford AcademicAntiandrogens for the Treatment of Hirsutism: A Systematic ...

In adolescents, physiologic pubertal hyperandrogenism, idiopathic hyperandrogenism, and PCOS can overlap clinically. Obtain total testosterone, free testosterone, or both when biochemical confirmation is needed, screen for nonclassic CAH with 17-hydroxyprogesterone, and use longitudinal evaluation when PCOS remains uncertain. Do not withhold symptomatic treatment solely because diagnostic labeling is still evolving. Wolters KluwerWolters KluwerScreening and Management of the Hyperandrogenic Adolescent

In postmenopausal patients, new androgen excess deserves a lower threshold for source-directed evaluation because ovarian and adrenal etiologies both occur and adrenal androgen-secreting adenomas, although exceptionally rare, have been reported. Document the modified Ferriman-Gallwey score and prioritize the tempo of new or worsening virilization. Oxford Academic+2Oxford AcademicAndrogen-Secreting Adrenal Adenoma in a Postmenopausal ...Oxford AcademicApproach to Investigation of Hyperandrogenism in a ...Oxford Academicinvestigation of postmenopausal androgen excess | The ...