General Medicine Conference “Hirsutism” General Medicine Conference “Hirsutism” Selim Krim,...
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Transcript of General Medicine Conference “Hirsutism” General Medicine Conference “Hirsutism” Selim Krim,...
General Medicine ConferenceGeneral Medicine Conference
“Hirsutism”“Hirsutism”
Selim Krim, MDSelim Krim, MDAssistant professorAssistant professor
Texas Tech University Health Sciences CenterTexas Tech University Health Sciences Center
OBJECTIVESOBJECTIVES
Define hirsutismDefine hirsutism
Get familiar with the Ferriman-Gallway scale to evaluate Get familiar with the Ferriman-Gallway scale to evaluate the extent of hair growththe extent of hair growth
Understand the pathogenesis of hirsutismUnderstand the pathogenesis of hirsutism
Be familiar with available therapiesBe familiar with available therapies
Use a stepwise approach when evaluating for hirsutismUse a stepwise approach when evaluating for hirsutism
CASECASE
A 19-year-old woman seeks care for slowly progressive hair growth. Since high school, she has shaved her upper lip weekly and waxed her abdomen and thighs monthly. Her menstrual periods are regular. Physical examination is unremarkable except for a body-mass index (the weight in kilograms divided by the square of the height in meters) of 31 and trace hair over the abdomen and thighs, with a moderate amount over her back. There is no clitorimegaly. How should this patient be evaluated and treated?
DEFINITIONDEFINITION
“ “Excessive terminal hair that appears in a male pattern (i.e., sexual Excessive terminal hair that appears in a male pattern (i.e., sexual hair) in women”hair) in women”
Deplewski et al. Endocr Rev 2000;21:363-92Deplewski et al. Endocr Rev 2000;21:363-92
CLASSIFICATIONCLASSIFICATION
PATHOGENESISPATHOGENESIS
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
HYPERTRICHOSISHYPERTRICHOSIS
Generalized excessive hair growth secondary to heredity Generalized excessive hair growth secondary to heredity or medications ( Steroids, phenytoin, Cyclosporine).or medications ( Steroids, phenytoin, Cyclosporine).
Hair is distributed in a Hair is distributed in a generalized, non sexual patterngeneralized, non sexual pattern..
Not causedNot caused by excess of androgens by excess of androgens
ETIOLOGIESETIOLOGIES
Normal androgen levels:Normal androgen levels:Idiopathic hirsutismIdiopathic hirsutism
Excess androgen levels:Excess androgen levels: Polycystic ovary syndromePolycystic ovary syndromeCongenital adrenal hyperplasiaCongenital adrenal hyperplasiaAndrogen secreting tumorsAndrogen secreting tumorsCushing’s syndromeCushing’s syndromeHyperprolactinemiaHyperprolactinemiaAcromegalyAcromegalyThyroid dysfunctionThyroid dysfunctionAndrogenic medicationsAndrogenic medications
DIAGNOSISDIAGNOSIS
History and physical exam helps ruling out other causes History and physical exam helps ruling out other causes of virilizing disorders, polycystic ovary syndrome, of virilizing disorders, polycystic ovary syndrome, medication use or other endocrinopathies.medication use or other endocrinopathies.
Look for evidence of Look for evidence of anovulation, obesity, metabolicanovulation, obesity, metabolic syndrome.syndrome.
A A rapid rapid pace of development or progression of hirsutism pace of development or progression of hirsutism or evidence of virilization (or evidence of virilization (Clitoromegaly or increasing Clitoromegaly or increasing muscularitymuscularity) should raise concern that an ) should raise concern that an androgen-androgen-secreting tumorsecreting tumor is present is present
STEPWISE APPROACH TO HIRSUTISMSTEPWISE APPROACH TO HIRSUTISM
MANAGEMENTMANAGEMENT
Cosmetic and physical measuresCosmetic and physical measures
Hormonal treatmentsHormonal treatments
Estrogen-progestin oral contraceptivesEstrogen-progestin oral contraceptives
AntiandrogensAntiandrogens
Other hormonal therapies: (Glucocorticoids, 5 alpha-Other hormonal therapies: (Glucocorticoids, 5 alpha-reductase inhibitors, metformin and thaizolidinediones)reductase inhibitors, metformin and thaizolidinediones)
AVAILABLE THERAPYAVAILABLE THERAPY
CASECASE A 19-year-old woman seeks care for slowly progressive hair
growth. Since high school, she has shaved her upper lip weekly and waxed her abdomen and thighs monthly. Her menstrual periods are regular. Physical examination is unremarkable except for a body-mass index (the weight in kilograms divided by the square of the height in meters) of 31 and trace hair over the abdomen and thighs, with a moderate amount over her back. There is no clitorimegaly. How should this patient be evaluated and treated?
Based on Ferriman-Gallway scale, this patient has mild hirsutismBased on Ferriman-Gallway scale, this patient has mild hirsutism
There are no signs of virilization and her menstrual cycles are regularThere are no signs of virilization and her menstrual cycles are regular
However the increase in her weight may warrant further testingHowever the increase in her weight may warrant further testing
Free testosterone levelsFree testosterone levels
CASECASE
A trial of eflornithine chloride cream may be tried for facial hirsutismA trial of eflornithine chloride cream may be tried for facial hirsutism
Encourage weight controlEncourage weight control
If hirsutism remains uncontrolled, oral contraceptives may be used If hirsutism remains uncontrolled, oral contraceptives may be used over a 9 to 12 months periodover a 9 to 12 months period
May also discuss the potential permanent benefit, risks, and cost of May also discuss the potential permanent benefit, risks, and cost of laser hair removallaser hair removal
Questions ?Questions ?
Thank youThank you