What is Hirsutism?
Hirsutism is the growth of terminal hair in women following a male pattern of distribution, 2 in androgen-dependent areas: sideburns, chin, neck, mammary areoles, thorax, in the area immediately above or below the navel, as well as in thighs and back. It is frequently associated with acne, male pattern baldness (androgenic alopecia), and menstrual irregularities.
This condition affects approximately 10% of women of childbearing age, and can be mild, representing a variation from the normal growth pattern, and is rarely a sign of a serious underlying disorder.
It is usually idiopathic but may be related to excess androgens, such as polycystic ovary syndrome or congenital adrenal hyperplasia.
It is determined by the increase in the levels or response to the ovarian or adrenal androgenic hormones (testosterone) that in the hair follicle are transformed into dihydrotestosterone by the action of the enzyme 5-alpha reductase, facilitating the conversion of hair into terminal hairs of the hair follicles with sensitivity to androgens. The boundary between normal and pathological is not precise, given ethnic variations and family influences. It is more common in whites and rare in Asians.
The clinical manifestations of androgenization may be due to global production of available free androgens due to a decrease in sex hormone transporting globulin (GTHS), or to an excessive local response, thanks to a greater affinity of intracellular receptors to bind to the hormone. Therefore, the origin of the problem can be central or peripheral.
What is the cause?
Central: Depending on the source of androgens, it will be ovarian, adrenal or pituitary, and it may be the tumour or functional mechanism.
Peripheral: in this case, the disorder will be located in the target organ, peripherally, thanks to an increase in skin sensitivity or peripheral enzyme hyperactivity.
The ovary seems to be the main source of excess androgen secretion, and the most frequently associated ovarian pathology is that which corresponds to polycystic ovary syndrome (functional ovarian hyperandrogenism).
Other rare causes of undesirable hair growth are:
- Use of phenytoin
- Tumour or cancer of the adrenal glands
- Ovarian tumour or cancer
- Cushing's syndrome
- Congenital adrenal hyperplasia
- Hyperthecosis (a condition in which the ovaries produce too many male hormones)
Use of certain medications such as testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, phenytoin.
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