Hirsutism - excessive hairiness male pattern in women, manifesting the appearance of a mustache and beard, excessive growth Hair on the trunk and limbs, mainly due to the increase in the concentration of androgens (male hormones) in blood.
Hirsutism often associated with menstrual irregularities and infertility. Subsequently may occur an increase in muscle mass, an increase in clitoral alopecia at the temples, roughness and voice enhancement of sexual desire. In addition, may show signs of defeminizatsii (for example, reducing the size of the mammary glands and termination of the formation of vaginal lubrication).
Causes of hirsutism
- Precocious puberty, menopause
- Idiopathic hirsutism (idiopathic syndrome of excess androgens) - poorly understood, but it is often observed a condition characterized by a slight hirsutism, acne and irregular menstrual periods without significant deviations gormnalnyh
- Receiving drugs (phenytoin, hexachlorobenzene, glucocorticoids, progestins, anabolic drugs, androgens).
- Disorders of adrenal origin (acquired or congenital adrenal hyperplasia, adrenal tumors)
- Disorders of ovarian origin (polycystic ovaries, Androblastoma, granulozotekakletochnaya tumor lyuteoma pregnant gipertekoz, chronic anovulation, amenorrhea)
- Disorder of pituitary origin (Cushing's syndrome, acromegaly)
- Genetic and chromosomal abnormalities
Diagnostics
Diagnosis of hirsutism carried endocrinologist with the use of special investigation techniques:
- Testosterone serum. total testosterone less than 200 ng / ml (decreases when taking oral contraceptives or prednisolone) are usually due to PCOS. total testosterone concentration of 200 ng / ml suggests the presence of tumor.
- dehydroepiandrosterone sulfate (DHEAS) serum - an indicator of the secretory activity of the adrenal glands. Concentration above 700 ng / ml, decreasing when receiving dexamethasone indicates adrenal hyperplasia. Elevated levels of DHEAS, is not reduced while taking dexamethasone, suggesting adrenal gland tumor.
- androstenedione Serum: elevated levels of androstenedione suggests ovarian disease
- 17-Hydroxyprogesterone serum increases in case of insufficiency of various enzymes (e.g., 21-hydroxylase activity observed with congenital adrenal hyperplasia
- cortisol: increase in cortisol concentration serum is in the syndrome of Cushing
- Gonadotropins: a relative increase in the ratio lyuteinziruyuschy hormone (LH) / Follicle stimulating hormone (FSH) Shows polycystic ovaries.
hirsutism treatment
- Removal of the ovaries or adrenal tumors
- Discontinuation of drugs that promote hair growth
- Suppression of adrenal androgens to prednisone or dexamethasone
- Treatment of the syndrome Cushing, hypothyroidism or acromegaly
- Drug therapy of hirsutism performed after eliminating tumors secreting androgens
- Oral contraceptives with antiandrogenic properties (e.g., Diana 35, Janine) - Selection drugs in idiopathic or associated with ovarian disease hirsutism. blood testosterone concentration is reduced for 1-3 months, which is accompanied by improvement. When reception contraindications to oral contraceptive administered medroxyprogesterone at a dose of 150 mg intramuscularly every 3 months. Contra-indications for all drugs - pregnancy.
- Antiandrogenic agents (administered at ineffective oral contraceptives) are less effective and have more side effects. Spironolactone (100-200 mg / day): Therapeutic effect develops slowly, side effects - increasing urinary volume, lowering blood pressure, uterine bleeding; contraindicated in pregnancy. Cyproterone (50 mg p 2 / day) usually take the drug together with an estrogen; the treatment there "breakthrough" bleeding, decreased sexual desire, and depression; contraindicated in pregnancy.
- Ketoconazole at a dose of 400 mg / day; contraindicated in pregnancy
Forecast
For a noticeable reduction of excessive hair growth may require 6-12 months of treatment. With long-term treatment of hirsutism outlook for the cessation of growth of new hair is good, and for the elimination of existing - doubtful. The goal of treatment of hirsutism - stop new hair growth process, rather than removing the old ones. After the appearance of coarse dark hair reduction of androgens will not affect the character of body hair. hirsutism treatment is not completely relieve from excessive hair growth, albeit slow their rate of growth.
Shaving hair is undesirable because this will lead to the need for daily shaving. Chemical products for hair removal often cause irritation to the skin, in the future may also need their daily use. Hair removal using wax provides a more prolonged effect compared to britom and chemical means. In patients with moderate hirsutism effectively bleaching the hair. Undesirable plucking long hair, because it often leads to scarring.
Radical additional measure - elektrolizis, causing the destruction of hair follicles (disadvantages - high cost, morbidity and long duration of the procedure).
The best long-term results gives a combination of hormonal and other methods of treatment of hirsutism.
