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Hirsutism. Max Brinsmead PhD FRANZCOG July 2012. Definition of Hirsutism. Terminal hairs in a female (or child) in a male pattern distribution and amount Hairs that are not regulated by androgens include: Scalp Eyebrows Eyelashes. Role of 5 -Reductase.
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Hirsutism Max Brinsmead PhD FRANZCOG July 2012
Definition of Hirsutism • Terminal hairs in a female (or child) in a male pattern distribution and amount • Hairs that are not regulated by androgens include: • Scalp • Eyebrows • Eyelashes
Role of 5-Reductase • Converts Testosterone to Dihydrotestosterone in hair follicles • Is increased in both idiopathic and other forms of hirsutism
Idiopathic Hirsuitism • Hirsutism with normal menstrual cycles and serum androgens • More common in Mediterranean, Middle Eastern and Southern Asian women • This means that the incidence of hirsutism is culturally determined • Up to 50% of Australian women complain of hirsutism
Medical Causes for Hirsutism • PCO Disorder 60 - 80% • Androgen-producing tumour • Congenital Adrenal Hyperplasia • Cushings Syndrome • Drugs
The clinical evaluation of hirsutism • When and where is the hair? • Weight and menstrual history • Family history • Drugs • Acne • Symptoms or signs of virilisation • Temporal hair loss • Voice change • Clitoral enlargement
Tests for a patient with hirsutism… • Androgens i.e. TEST, SHBG & FAI • HydroxyPROG • DHEAS • PROL & TSH • Ovarian ultrasound
Treatment options for hirsutism… • Counselling • Cosmesis • Combined Oral Contraceptive • Cyproterone acetate • With or without COC e.g. Diane • Spironolactone • Causes irregular periods • Topical Eflornithine