Makindo Medical Notes

Related Subjects: | Adrenal Adenomas | Adrenal Cancer

🧠 Introduction

Hirsutism refers to excessive, male-pattern hair growth in women, most prominently on the face, chest, and abdomen. It reflects increased androgen activity at the hair follicle and may result from endocrine disorders, drugs, or idiopathic causes. When accompanied by deeper voice, clitoromegaly, or increased muscle mass, the term virilism is used.

💡 Clinical importance: Hirsutism is a visible marker of underlying hormonal imbalance — often revealing polycystic ovary syndrome (PCOS), adrenal pathology, or androgen-secreting tumours.

🔬 Pathophysiology

• Hair growth in androgen-dependent sites is controlled by dihydrotestosterone (DHT), converted from testosterone by 5α-reductase.
• Androgens are derived from both the ovaries and adrenal glands.
• Excess androgen exposure stimulates terminal hair growth, sebaceous activity (→ acne), and occasionally virilisation.

📋 Major Causes of Hirsutism

🩸 Summary of Aetiologies

🧠 Clinical Pearls

• 🔍 Rate of onset is key — rapid progression (<6 months) suggests a tumour; gradual onset suggests PCOS or idiopathic causes.
• 🩺 Virilisation (deep voice, clitoromegaly) always warrants urgent imaging for an androgen-secreting tumour.
• ⚖️ Hirsutism score: The Ferriman–Gallwey scale quantifies severity across 9 androgen-sensitive sites (0–36 scale; >8 = abnormal).
• 💊 COCP is first-line therapy unless contraindicated; it reduces LH-driven ovarian androgen synthesis.
• 💪 Spironolactone blocks androgen receptors but is teratogenic — combine with contraception.
• 🧬 CAH screening is especially important in early-onset or familial cases.

📚 References

• NICE Clinical Knowledge Summary: Hirsutism in Women (2023).
• Fauser BCJM et al. Polycystic Ovary Syndrome: Consensus Definition. Fertil Steril. 2012.
• Melmed S et al. Williams Textbook of Endocrinology, 14th ed.
• Royal College of Obstetricians & Gynaecologists. Green-top Guideline No. 33 – Management of Hirsutism (2022 update).