An Approach to the Patient With Hirsutism

摘要

This review provides a guide for diagnosis and management of hirsutism. The majority of women who see an en-docrinologist complaining of hirsutism are endocrinologically normal and derive no benefit from an endocrinologic evaluation. Idiopathic hirsutism refers to a woman who has normal serum androgen concentrations, no irregular menses, and no identifiable cause of her hirsutism. Most such patients can be treated using cosmetic measures. The cause of excess hair growth in most women who require an endocrinologic evaluation is hyperandrogenism due to polycystic ovary syndrome (PCOS) and other obesity-related disorders. Other causes of androgen excess occur much less frequently: Late onset or nonclassic congenital adrenal hyperplasia (CAH) in less than 3% of women and androgen-secreting tumors in 0.2%. Polycystic ovary syndrome and other obesity-related causes of insulin resistance, as well as nonclassic CAH, typically begin in the pubertal years and tend to plateau during the reproductive years. Testing for elevated androgen levels in women should be performed in women with moderate or severe hirsutism or hirsutism that is sudden in onset, rapidly progressive, or associated with menstrual irregularity, infertility, or obesity. In patients with plasma testosterone levels greater than 200 ng/dL, the cause is usually an adrenal tumor.