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PubMed2004

Personality, manual preference and neuroendocrine reactivity in hirsute subjects.

Behavioral and neuroendocrine differences may be postulated in hirsute subjects since central effects of gonadal steroids are well established. We conducted a controlled clinical study with 25 consecutive young hirsute participants compared with 20 consecutive controls. Neuropsychological evaluation included the Minnesota Multiphasic Personality Inventory (MMPI) and the Edinburgh Inventory of Manual Preference (EIMP). Neuroendocrine reactivity was assessed by the adrenocorticotropic hormone (ACTH) and cortisol responses to corticotropin releasing hormone (CRH). Hirsute participants presented a flattened personality profile with lower neurotic triad scores--146 +/- 20 versus 166 +/- 28. Left-hand preference was more common in hirsute participants--4/21 versus 0/20. Decreased ACTH [area under the curve (AUC)--36 +/-2 8 vs. 72 +/- 63 pg/ml h] and cortisol (AUC--18 +/- 4 vs. 25 +/- 10 microg/dl h) responses to CRH were found in the hirsute group. In the hirsute group, higher manual preference scores were associated with lower ACTH responses to CRH, while the opposite association was found in the control group. In the hirsute group, the hyporeactive hypothalamic-pituitary-adrenal (HPA) axis was associated with lower behavior-deviant scores, while in the control group, the hyporeactive HPA axis was associated with more psychopathology. We conclude that personality and HPA axis reactivity are different in hirsute female participants when compared with controls, with a trend for differences regarding handedness. Personality and handedness are differently associated with HPA reactivity. Distinctive features in hirsute participants are probably established very early during ontogenic development.

Adrenocorticotropic Hormone↗
PubMed1994

Serum levels of androstanediol glucuronide, total testosterone, and free testosterone in hirsute women.

OBJECTIVE: To determine the serum levels of androstanediol glucuronide (3 alpha-diol G), total T, and free T in hirsute and nonhirsute women. DESIGN: Controlled clinical study. PATIENTS: Hirsute women with oligomenorrhea, hirsute women with regular ovulatory cycles, and nonhirsute women with regular cycles were selected. MAIN OUTCOME MEASURE: Serum levels of 3 alpha-diol G, total T, and free T were measured in 8 hirsute with oligomenorrhea and 11 hirsute women with regular ovulatory cycles and compared with 20 nonhirsute women with regular cycles (control group). Serum 3 alpha-diol G was also measured during the follicular, periovulatory, and luteal phases in hirsute women with regular cycles. RESULTS: Serum levels of 3 alpha-diol G did not change during the menstrual cycle, in addition we observed that there was no difference between the levels of 3 alpha-diol G, total T, and free T in hirsute women with regular cycles when compared with normal women. These three serum androgens were elevated only in the hirsute women with oligomenorrhea. Besides, there was better correlation between total T and free T (r = 0.81) than total T and 3 alpha-diol G (r = 0.49) or free T and 3 alpha-diol G (r = 0.66). CONCLUSION: The findings suggest that serum 3 alpha-diol G does not provide additional benefit as a marker of hirsutism than serum total or free T.

Adolescent↗
PubMed1995

Clinical and endocrine effects of finasteride, a 5 alpha-reductase inhibitor, in women with idiopathic hirsutism.

OBJECTIVE: To evaluate the effects of long-term administration of finasteride on hirsutism score, basal gonadotropin, and androgen secretion in women with idiopathic hirsutism. DESIGN: Randomized single-blinded study. PATIENTS: Eighteen patients with moderate-severe hirsutism were recruited for the study. INTERVENTIONS: Nine hirsute patients received 7.5 mg/d oral finasteride for a period of 9 months whereas the other nine were treated with placebo. Hirsutism score, serum basal gonadotropin, androgens, estrogen, and sex hormone-binding globulin (SHBG) levels were evaluated in all patients before treatment and every 3 months during treatment. RESULTS: After 6 and 9 months of treatment, the hirsutism score improved significantly in the patients receiving finasteride, whereas no significant modifications were observed in patients treated with placebo. The side effects observed were headache and depression of modest entity during the 1st month of treatments, whereas libido did not change. Serum levels of LH, FSH, androstenedione, unbound T, DHEAS, E2, 17 alpha-hydroxyprogesterone, and SHBG did not change during therapy. Hirsute patients treated with finasteride exhibited a marked decrease of dihydrotestosterone and a significant increase of T serum levels from the 3rd and 6th months of treatment, respectively. CONCLUSION: Finasteride decreased the hirsutism score of patients affected by idiopathic hirsutism with few side effects during treatment. No modification of libido was observed.

5-alpha Reductase Inhibitors↗
PubMed2003

The evaluation and management of hirsutism.

Hirsutism is the presence of terminal (coarse) hairs in females in a male-like pattern, affecting between 5% and 15% of women, depending on definition. Hirsutism has a significant negative impact on psychosocial development and is usually a sign of an underlying endocrine abnormality-namely, androgen excess. The most common cause of androgen excess is the polycystic ovary syndrome (PCOS), with 21-hydroxylase-deficient nonclassic adrenal hyperplasia, the hyperandrogenic insulin-resistant acanthosis nigricans syndrome, androgen-secreting tumors, and androgenic drug intake occurring less frequently. However, although 70-80% of patients with androgen excess demonstrate hirsutism, this sign may be less prevalent among women of Asian extraction. Conversely, not all hirsute patients have evidence of detectable androgen excess, as 5-15% of these women have "idiopathic hirsutism," with normal ovulatory function and androgen levels. There is a strong familial predilection for hirsutism, primarily because the underlying endocrine disorders (eg, PCOS) and the factors regulating the development of hair growth (eg, androgen receptor activity, 5alpha-reductase activity) have a strong genetic component. The diagnostic evaluation of the potentially hirsute patient first involves confirming the presence of hirsutism and then excluding associated or etiological abnormalities and disorders (eg, ovulatory dysfunction, adrenal hyperplasia, diabetes, thyroid hormone abnormalities). Treatment should be undertaken using combination therapy, to possibly include 1) hormonal suppression (oral contraceptives, long-acting gonadotropin-releasing hormone analogues, and insulin sensitizers), 2) peripheral androgen blockade (spironolactone, flutamide, cyproterone acetate, or finasteride), and 3) mechanical/cosmetic amelioration and destruction of the unwanted hairs (electrology and, potentially, laser hair removal). The application of eflornithine hydrochloride 13.9% topical cream may also be useful to ameliorate unwanted facial hair growth. Overall, although hirsutism is a frequent and distressing abnormality often signaling an underlying endocrine disorder, a systematic approach to evaluation will uncover the etiology, and combination therapy will provide satisfactory treatment for most patients.

Androgen Antagonists↗
PubMed2000

Relapse of hirsutism following long-term successful treatment with oestrogen-progestogen combination.

OBJECTIVE: While several forms of treatment have been reported to be successful in relieving hirsutism over periods of 6-12 months, there is little if any information on the long-term outcome of hirsutism following the withdrawal of successful treatment. The combination of ethinyl oestradiol, 35 micrograms, and cyproterone acetate, 2 mg (EE-CA) for 21 days followed by 7 days without treatment is widely used in a cyclical manner in the treatment of hirsutism. The present study was undertaken to evaluate the outcome of withdrawal of long-term successful treatment of hirsutism with EE-CA. DESIGN, PATIENTS AND MEASUREMENT: In this retrospective study the clinical records of 57 patients with idiopathic hirsutism or polycystic ovary syndrome who had been treated with EE-CA were reviewed. The degree of hirsutism had been assessed by the Ferriman and Gallwey scoring system (FG). The testosterone/sex hormone binding globulin ratio (T/SHBG), was derived prior to and following the introduction of treatment with EE-CA. RESULTS: Fifty-two of the 57 patients achieved a satisfactory clinical response. In the group of patients who were satisfied with the outcome of treatment, FG decreased from 12.9 +/- 3.6 to 5.5 +/- 2.5 and T/SHBG ratio decreased from 11.3 +/- 9.5 to 1 +/- 0.8 (reference range: 1-5.2). The duration of treatment prior to its withdrawal in this group was 28.2 +/- 13.7 months. The five patients who were not satisfied with the response abandoned treatment after 16 +/- 2.8 months; the pretreatment FG was 16.2 +/- 8.3, while the T/SHBG decreased from 6.1 +/- 3.1 to 1.1 +/- 0.6 in these patients. Subsequent follow-up data, after withdrawal of treatment, were available on 34 of these 52 patients. Twenty-eight of the 34 patients exhibited relapse of hirsutism after 6.15 +/- 2.8 months. Six patients did not relapse during a follow-up period of 18.8 +/- 7. 8 months. The six patients who did not relapse were treated for a significantly longer period than the group who relapsed, 40 +/- 6.9 and 26.1 +/- 8.3 months, respectively, P < 0.01. However, the groups did not differ significantly when examined for pretreatment FG, 11.5 +/- 3.8 and 13.2 +/- 3.6 and pretreatment T/SHBG 8.9 +/- 5 and 13.4 +/- 11.9. CONCLUSION: These data indicate that ethinyl oestradiol and cyproterone acetate achieved a satisfactory clinical outcome in the treatment of hirsutism in 90% of patients. However, on withdrawal of treatment after a mean duration of over 2 years, relapse occurred in 80% of these patients after a mean of 6 months. If it is assumed that the successfully treated patients lost to follow-up all maintained long-term remission, the relapse rate is still an unsatisfactory 65% at 6 months. These are disappointing results which indicate for the first time that successful outcome requires that treatment be maintained for several years. Patients embarking upon treatment for hirsutism should be advised that maintenance of reduced hair growth requires long-term treatment, probably for at least 3-4 years.

Adult↗
PubMed2004

High serum prostate-specific antigen concentrations in hirsute women do not decrease with treatment by the combination of spironolactone and the contraceptive pill.

Using an ultrasensitive assay, prostate-specific antigen (PSA) has been detected in female serum and has been proposed as a potential marker of androgen excess in hirsute women. Measurement of PSA levels in serum may play a role in monitoring hirsutism during antiandrogen therapy. We investigated the role of PSA as a marker of androgen activity in hirsute patients taking spironolactone together with oral contraceptive pills containing ethinyl estradiol and gestodene. Twenty-eight hirsute patients were included in the study. Clinical and biochemical variables including serum levels of PSA (using an ultrasensitive chemiluminscent immunoassay), dehydroepiandrosterone sulfate, total testosterone, free testosterone and 17-hydroxyprogesterone concentrations were recorded at baseline and after six cycles of treatment. Fifteen healthy women were included in the study as controls. Serum PSA levels in hirsute women were clearly higher than in the control group (0.023 +/- 0.004 vs. 0.006 +/- 0.003 ng/ml, p < 0.001) and correlated with baseline serum free testosterone concentrations (r = 0.518, p = 0.005). After 6 months, serum PSA concentrations as compared with baseline values did not change significantly in patients who were given spironolactone plus contraceptive pills (p = 0.4) despite a marked decrease in total testosterone, free testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate and hirsutism score (p < 0.05). Thus, serum PSA levels in hirsute women were higher than in non-hirsute healthy controls. A 6-month course of treatment with spironolactone combined with contraceptive pills containing ethinylestradiol and gestodene did not reduce high serum PSA levels in these subjects. In conclusion, the serum PSA level is not a convenient biochemical marker with the available assays for the management of hirsute women treated with the combination of spironolactone and oral contraceptives.

17-alpha-Hydroxyprogesterone↗
PubMed1997

Gonadotrophin-releasing hormone agonist therapy for hirsutism is as effective as high dose cyproterone acetate but results in a longer remission.

Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone agonist (GnRHa) have been shown to be effective for the treatment of hirsutism. We wished to compare the effectiveness of CPA in two standard doses with GnRHa and add-back therapy and to compare the length of remission after these treatments. A total of 60 hirsute hyperandrogenic women was assigned to the following treatment groups: CPA 2 mg with 35 microg of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg, days 5-15, and ethinylestradiol 50 microg, days 5-25, each month (CPA group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate 10 mg, days 12-21 (GnRHa group). Hirsutism was graded by the Ferriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters and serum luteinizing hormone (LH) and testosterone were assessed before and every 3 months during and after treatment. All women were treated for 1 year with 1 year follow-up. At baseline hirsutism and endocrine patterns were similar in all groups. After one year of treatment, hirsutism decreased in all groups but the changes were greater (P <0.05) in the CPA and GnRHa groups than in the Diane group. Serum LH and testosterone were lowest in the GnRHa group. After withdrawal, hirsutism increased rapidly in the Diane and CPA groups and after 6 months, FGL scores and hair shaft diameters were similar to pretreatment values. In the GnRHa group, hirsutism increased more gradually and after 1 year of withdrawal, FGL scores and hair diameters were significantly (P <0.05) less than pretreatment values. Serum LH and testosterone increased rapidly in all three groups reaching pretreatment values by 6 months. These data suggest equal efficacy of the GnRHa and the high dose CPA regimen for the treatment of hirsutism in hyperandrogenic women. GnRHa with add-back treatment appears to result in a longer remission of hirsutism in comparison with CPA.

Adult↗
PubMed1984

The effect of endogenous progesterone on serum levels of 5 alpha-reduced androgens in hirsute women.

This study was to examine indirectly the effect of endogenous progesterone, a known competitor for 5 alpha-reductase, on androgen metabolism in target organs in hirsute women. Serum levels of progesterone, testosterone (T), androstenedione (A), dihydrotestosterone (DHT) and 5 alpha-androstane 3 alpha 17 beta-diol (3 alpha-diol) and sex hormone binding globulin (SHBG) were assessed serially over a four week period in normal women, six hirsute women with regular menstrual cycles, eight hirsute women with oligomenorrhoea (and presumptive polycystic ovaries) and seven non-hirsute women with oligomenorrhoea. Serum T and A levels were significantly higher than normal in both hirsute and non-hirsute women with oligomenorrhoea, while serum SHBG was significantly lower than normal in the two groups of hirsute women. The calculated free T level was higher than normal in all three groups of patients. DHT levels were not significantly different from normal in any of the three groups of patients. The 3 alpha-diol level showed considerable overlap with normal in all groups of patients and was only significantly higher than normal in hirsute women with oligomenorrhoea (P less than 0.05). There was a small fall in DHT in the late luteal phase of the cycle of those women with a sustained rise in serum progesterone in the second half of the cycle, but no change in serum 3 alpha-diol. These studies suggest that serum 3 alpha-diol may not be as good an indicator of peripheral androgen metabolism in hirsute women as previously reported and that a rise in serum progesterone has only a minimal effect on circulating levels of the active 5 alpha-reduced androgen metabolites. Although in vitro 3 alpha-diol has been shown to be a potent inhibitor of 5 alpha-reductase this casts doubt on its role in this regard in vivo.

Adolescent↗
PubMed1990

Androsterone glucuronide is a marker of adrenal hyperandrogenism in hirsute women.

Androsterone glucuronide (Andros-G), a dihydrotestosterone metabolite, is present in serum at concentrations at least tenfold greater than those of androstanediol glucuronide. To investigate the significance of serum androsterone glucuronide, we developed a direct radioimmunoassay for this compound and measured its levels in normal women, women with mild or severe idiopathic hirsutism (IH), hirsute women with polycystic ovarian syndrome (PCO), and non-hirsute obese women. To determine the source of Andros-G precursors, serum levels were measured before and after selective ovarian suppression with leuprolide, combined ovarian and adrenal suppression with leuprolide and dexamethasone, and adrenal stimulation with ACTH. Androsterone glucuronide levels (nmol/l; mean +/- SD) were significantly higher (P less than 0.025) in women with mild idiopathic hirsutism (IH) (185 +/- 91), severe IH (173 +/- 97), and hirsute women with polycystic ovarian syndrome (PCO) (178 +/- 102) than in normal women (110 +/- 26). Levels in non-hirsute obese women (64 +/- 19) were lower than in normal women (P less than 0.01). Baseline levels (mean +/- SEM) in hirsute women given 20 micrograms/kg/day leuprolide for 5-9 months (171 +/- 15) were not significantly changed after leuprolide alone (153 +/- 18), and were decreased after adding dexamethasone (19 +/- 6; P less than 0.001). Andros-G levels did not increase significantly in normal women 60 min after i.v. ACTH (112 +/- 14 to 126 +/- 19), but rose in IH (170 +/- 24 to 216 +/- 26; P less than 0.001) and in PCO (179 +/- 26 to 238 +/- 31; P = 0.002). We conclude that Andros-G in women arises primarily from adrenal gland precursors and is elevated in hirsute women as a group. Its levels do not correlate with the severity of hirsutism, or the presence or absence of PCO, but reflect an increased production of adrenal androgens in both IH and PCO.

Adrenal Glands↗
PubMed1997

Augmentation of bone mineral density in hirsute women.

Hirsutism is associated with both hyperandrogenism and oligomenorrhea or amenorrhea, which have opposing effects on bone mineral density (BMD). We tested the hypothesis that hyperandrogenism in hirsute women counteracts the osteopenic effects of menstrual dysfunction. Using dual energy x-ray absorptiometry, we measured BMD and total bone mineral content (BMC) in 32 young women referred for hirsutism. The control group consisted of 25 matched, nonhirsute women. Among the hirsute women, 21 reported regular menses, and 11 gave a history of oligomenorrhea; all members of the control group reported regular menses. Compared with controls, hirsute women had higher total BMD (1.202 +/- 0.02 vs. 1.116 +/- 0.02 g/cm2, P < 0.01), lumbar spine BMD (1.183 +/- 0.02 vs. 1.125 +/- 0.02 g/cm2, P < 0.01), and total BMC (2700 +/- 66 vs. 2400 +/- 70 g, P < 0.001). Serum total testosterone levels were similar, but androstenedione levels were higher (11.7 +/- 0.80 vs. 7.9 +/- 0.79 nmol/L, P < 0.005) and sex hormone binding globulin levels lower (22.0 +/- 3.0 vs. 57.6 +/- 8.5 nmol/L, P < 0.001) in hirsute women than controls. Oligomenorrheic hirsute women had higher BMD than nonhirsute women, although the augmentation was less pronounced than in eumenorrheic hirsute women. These results indicate that hirsutism is associated with higher bone density and mineral content, consistent with a net positive effect of hyperandrogenism on skeletal mass.

Adolescent↗
PubMed2000

Serum prostate-specific antigen concentrations are not useful for monitoring the treatment of hirsutism with oral contraceptive pills.

Prostate-specific antigen (PSA) is produced in several female tissues, under the regulation of steroid hormones. Serum PSA levels are increased in women with hirsutism, and they correlate with serum androgen levels. Therefore, as a marker of androgen excess, measurement of serum PSA may play a role in monitoring the treatment of hirsutism with contraceptive pills. Sixteen hirsute patients were included in the study. Clinical and biochemical variables, including serum PSA (using an ultrasensitive chemiluminescent immunoassay), total testosterone, sex hormone-binding globulin, androstenedione, dehydroepiandrosterone-sulfate, estradiol, and gonadotropin concentrations were recorded at baseline and after 3 and 6 cycles of treatment with a monophasic contraceptive pill containing ethynylestradiol and desogestrel. Twenty-seven healthy women served as controls for serum PSA level and for the serum androgen profile. Serum PSA levels were higher in hirsute patients, as compared with healthy women (mean +/- SEM: 0.014 +/- 0.003 vs. 0.006 +/- 0.001 microg/L, P < 0.02). Despite a marked decrease in serum androgens (total testosterone and androstenedione, calculated free testosterone and free androgen index; and dehydroepiandrosterone-sulfate) and in the hirsutism score, and a marked increase in sex hormone-binding globulin levels, serum PSA levels did not change and remained detectable in all the hirsute patients after 3 and 6 cycles of treatment with contraceptive pills. In conclusion, the increased serum PSA levels present in hirsute patients do not change during treatment with contraceptive pills and do not parallel the amelioration in hirsutism and the decrease in serum androgen concentrations that occur during this treatment. Thus, serum PSA measurements have no apparent role in the management of hirsute patients on oral contraceptive treatment, at least with the ultrasensitive assays currently available.

Adult↗
PubMed1984

Prolactin in hirsute women: possible roles for androgens in suppressing basal levels, and for oestrogens in enhancing TRH-induced responses.

Hyperprolactinaemic patients occasionally demonstrate hirsutism and elevated levels of DHA-S, a weak androgen of adrenal origin. Abnormal adrenal function is frequently observed in hirsute patients. These observations prompted speculation that prolactin may modulate normal adrenal secretion and that derangements of adrenal androgen secretion may be due to abnormalities in prolactin. In this study we examined the possibility that elevated prolactin levels may be involved in the pathogenesis of hyperandrogenaemia in hirsute patients. However, basal prolactin levels in hirsute women, with or without menstrual disturbances, 201 +/- 24.3 mU/l (mean +/- SE) and 192 +/- 24.3 mU/l respectively, were significantly suppressed below levels in normal women, 289 +/- 12.2 mU/l. The prolactin responses to stimulation with TRH and to suppression with L-dopa were also studied in hirsute patients. The prolactin response to TRH (maximum increment or integrated response) was exaggerated significantly in hirsute women with menstrual disturbances when compared to normal women, to hirsute women with normal menses or to normal men. This abnormal response may have been due to elevated oestrone levels present in patients with oligomenorrhoea (318 +/- 49.5 pmol/l compared to 191 +/- 12.1 pmol/l in normal women and 161 +/- 15.5 pmol/l in hirsute women with normal menses, P less than 0.05). There were no abnormalities detected in the suppression of prolactin in response to L-dopa in any of these groups. These findings do not support a role for prolactin in the pathogenesis of hyperandrogenaemia in hirsute patients. However, elevated androgen levels in women may bring about suppression of basal prolactin levels to values seen in normal men. (ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Glands↗
PubMed1993

Hormonal status and clinical relevance of hirsutism in elderly women.

Hirsutism is a common condition of elderly women, but its aethiopathogeny and its clinical implications remain unclear. We therefore studied circulating androgen concentrations in elderly women. In addition, this study aims to define a possible relationship between hirsutism and anthropometric determinations, bone mass and serum lipids. Androgen levels were determined at basal state, after adrenocorticotrophin (ACTH) stimulation and after dexamethasone administration in 10 hirsute elderly women and compared to 10 age-matched non-hirsute women. Anthropometric determinations included measurements of skinfold thickness and body mass index. Spinal bone mass density was assessed using dual photon absorptiometry. Hirsute women presented significantly higher levels of testosterone than controls (1.49 +/- 0.38 vs 0.59 +/- 0.05 nmol/l, mean +/- SEM; p < 0.05) and dihydrotestosterone (0.54 +/- 0.07 vs 0.32 +/- 0.03; p < 0.02). 17-hydroxyprogesterone levels after ACTH stimulation tended to be higher in hirsute women than in controls. No differences were observed between the two groups in serum oestrogen concentrations, plasma lipid pattern or bone mineral density. Hirsute women had a lower body mass index and lower calculated percentage body fat than the control group. We conclude that: (i) hirsutism of elderly women is associated with increased androgen levels, probably from adrenal origin; (ii) in some cases, enhanced response in 17-hydroxyprogesterone after ACTH stimulation suggests a partial adrenal 21-hydroxylase deficiency; (iii) hirsute women present anthropometric characteristics compatible with the known anabolic effect of androgens on fat-free mass.

Adrenocorticotropic Hormone↗
PubMed2001

Hirsutism of adrenal origin in adolescents: consequences in adults.

Hirsutism is a common clinical and psychological problem in women. Polycystic ovary syndrome and idiopathic hirsutism are the most common causes of hirsutism. Adrenal disorders are less common causes of hirsutism; the most common adrenal cause of hirsutism is non-classical congenital adrenal hyperplasia (NC-CAH). Hirsutism may be the presenting symptom of an adrenal carcinoma or adenoma. In this review, adrenal causes of hirsutism, the pathophysiology of the hirsutism in NC-CAH, and the treatment of hirsutism in these patients, are discussed.

Adolescent↗
PubMed1987

The relationship of mild hirsutism or acne in women to androgens.

The relationship in women between mild hirsutism or acne to androgen levels has not been well-defined. We investigated this in 62 Caucasian women, aged 18 to 21 years, by relating these pilosebaceous signs to plasma free testosterone (fT), the main circulating determinant of plasma androgenicity. Women with mild hirsutism (n = 13) had a significantly elevated fT (12.7 +/- 5.5, SD, pg/mL [44.1 +/- 19.1 pmol/L]) compared to normal controls (7.4 +/- 2.7 pg/mL [25.7 +/- 9.4 pmol/L]), as did subjects with minor acne (10.7 +/- 4.25 pg/mL [37.1 +/- 14.7 pmol/L]). The most important finding was the striking variability in the relationship between pilosebaceous overactivity and fT levels. In mildly hirsute subjects plasma fT was normal in half of the subjects, and the coefficient of variation of plasma fT was about twice what one would expect from individual variability. We could not demonstrate correlations among the variables of hirsutism, acne, and plasma fT. On the other hand, among 15 women with modest elevations of plasma fT levels (up to twofold), 27% had moderate hirsutism, 40% had mild hirsutism, and 33% had none. However, four of five of the latter patients (without hirsutism) had acne. The relationship of fT to acne severity varied similarly. To define the interactions between androgens and the pilosebaceous apparatus, we propose a model in which variation in apparent skin sensitivity and the level of androgen seem to contribute about equally to the pathogenesis of mild hirsutism and acne. The clinician should suspect that hyperandrogenemia will be found in about half the women with mild cases of hirsutism, and one third with minor acne.

Acne Vulgaris↗
PubMed1984

Adrenal corticoid hyperresponsiveness in hirsute women.

Data are limited on the existence of adrenal hyperplasia or cortisol oversecretion in women with hirsutism. Supranormal responses of cortisol (greater than 20 micrograms/dl) were observed at 15 and 30 minutes after the 8:00 A.M. adrenocorticotropin (0.5 U) injection (performed after 1 mg of dexamethasone taken orally at midnight) in 6 of the 12 hirsute women (hirsute I) and in all 4 women with Cushing's disease. Baseline plasma levels of corticoids, androgens, and gonadotropins, body weight, menstrual history, and degree of hirsutism were all indistinguishable between the two hirsute groups. The mean plasma levels of cortisol and 17-hydroxyprogesterone were both significantly greater in the hirsute I group and in those with adrenal hyperplasia caused by Cushing's disease than in normal subjects. Our data indicate that adrenal hyperplasia is a common abnormality in women with hirsutism. We speculate that this abnormality may contribute to the pathogenesis of hirsutism and ovarian dysfunction in many hirsute women.

Adolescent↗
PubMed2007

Clinical presentation and etiologic factors of hirsutism in premenopausal Iranian women.

BACKGROUND: Hirsutism is a common clinical condition with different etiologies. Many of these patients have frank or subclinical abnormalities in the adrenal and ovarian steroidogenesis. The disease may be associated with other clinical signs of hyperandrogenism. The objective of this study was to investigate the clinical features of hirsutism and its etiologic factors in premenopausal Iranian women. METHODS: In a cross-sectional study, 790 consecutive premenopausal women referred to the dermatology Clinics of Hazrat-e Rasool and Firoozgar University Hospitals and three private dermatology clinics during 2001 - 2003 with the clinical diagnosis of hirsutism were studied. All patients underwent detailed clinical assessment and transabdominal ultrasonography of the ovaries. Endocrinologic work-up was performed for 285 patients. RESULTS: Hirsutism was mild in 65%, moderate in 32.5%, and severe in 2.5% of the patients. Positive family history was found in 56.2%. Hormonal studies revealed some abnormalities in 35.2% of the patients. Coexisting medical conditions included acne in 70% of the patients, menstrual irregularity in 38.6%, androgenic alopecia in 21.3%, obesity in 6.5%, acanthosis nigricans in 4.9%, and diabetes in 0.6% of the patients. Etiology of hirsutism was identified as polycystic ovary syndrome (62.53%), idiopathic (35.19%), congenital adrenal hyperplasia (0.38%), prolactinoma (0.13%), and undetermined (1.77%). Polycystic ovary syndrome was diagnosed more frequently in women with menstrual irregularity than eumenorrheic patients (97.70% vs. 40.41%, P < 0.001). CONCLUSIONS: Hirsute patients frequently have either elevated androgen levels or clinical conditions associated with hyperandrogenemia. Eumenorrhea does not rule out endocrine abnormality and particularly polycystic ovary syndrome which is a common cause of hirsutism. We recommend performing endocrinologic work up, investigation of coexisting hyperandrogenic states, and evaluation of polycystic ovary syndrome in all patients with hirsutism.

Adolescent↗
PubMed1982

Hirsutism and menstrual patterns in women exposed to diethylstilbestrol in utero.

Hirsutism and menstrual patterns were evaluated in 32 female patients with documented diethylstilbestrol (DES) exposure in utero. Nine nonhirsute regularly menstruating and nine consecutive hirsute oligomenorrheic women with no known DES exposure served as controls. Hormone measurements included follicle-stimulating hormone, luteinizing hormone, prolactin, cortisol, testosterone, androstenedione, dehydroepiandrosterone, sex hormone-binding globulin, and estradiol. Hirsutism was present in 72% and irregular menses occurred in 50% of DES-exposed patients. The mean age of the DES-exposed group was 26.8 +/- 0.7 years (mean +/- SEM). The mean age of mildly hirsute DES-exposed patients (24.7 +/- 1.4 years) was significantly lower (p less than 0.05) than that of severely hirsute DES-exposed patients (28.8 +/- 1.1 years). Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding severely hirsute DES-exposed group but higher than in nonhirsute control subjects. Mean testosterone, androstenedione, sex hormone-binding globulin, testosterone/sex hormone-binding globulin, and luteinizing hormone levels in hirsute DES-exposed patients were similar to those in hirsute control subjects but significantly higher than those in nonhirsute control subjects. Mean DHA levels as well as the clitoral indices were comparable in all groups. Our data suggest that DES exposure in utero may result in hypothalamic-pituitary-ovarian dysfunction.

Androstenedione↗