Conditions and diseases that cause hirsutism

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An insight into the Causes of Hirsutism

Hirsutism can be defined as the presence of excessive coarse terminal hairs in a human body. In a woman body this growth manifests in the androgen-dependent areas like beards, chest or sexual hairs. Terminal hairs sprout from androgen-sensitive pilosebaceous units.

Many women worldwide of reproductive age are hirsute with male like coarse excess hair growth. This excess growth of hair on face and body is often a cause of social stigma, giving rise to psychological problems like distress, anxiety, depression and a miserable life. Not only psychological cons the finger of hirsutism is pointed towards some underlying medical conditions.

Diving into the roots of hirsutism

Hirsutism happens from increased androgen actions on hair follicles from the augmented endogenous or exogenous circulating levels of androgen. This disorder may also result from the over sensitivity of hair follicles to normal levels of circulating androgens. It is a result of skulking central endocrine or follicular abnormality.

There may be serious pathological reasons other than these like tumors, late-onset adrenal hyperplasia, Polycystic ovary, Cushing’s syndrome and such other conditions.

Hair growth varies with race or species and to know if it is indeed true hirsutism, you must distinguish between the normal growth and growth due to hirsutism. Science shows that the bodies of 60% to 80% of women who suffer from hirsuitism experience greater level of circulating androgen but the correlation between the degrees of hirsutism and androgen levels are poor. The ovary of the woman who is suffering from hirsutism is the chief organ for increased testoterone.

An androgen, Dehydroepiandrosterone Sulphate (DHEAS) that arises exclusively from the adrenal gland (though rarely) can be the cause of hirsutism.

Probing into the causes of hirsutism

Before we lunge into the probable causes of hirsuitism it is better to remember that it is a sign of hyperandrogenism.

The causes of increased androgen level in hirsutism include:

Familial and idiopathic hirsutism

These are common causes of hirsutism resulting from peripheral androgen goings-on. It begins in puberty and slowly steps forward. The patients have normal menses, normal testosterone level, 17alpha hydroxyprogesterone and DHEAS. The diagnosis stands on exclusion.

Idiopathic cause

Idiopathic cause triggers hirsutism in 6% to 17% of hirsute women. Hirsutism occurs in the body where the circulating levels of androgens and ovulation are normal. The pathophysiological indicators are exaggerated peripheral 5 alpha reductase activity, altered androgen metabolism or different functioning androgen receptors.

Excess secretion by the ovaries (For example tumors, polycystic ovary syndrome (PCOS))

The most common example is polycystic ovary syndrome, which affects 6% women of the reproductive age bracket. Over 70% patients with PCOS have signs of hyperandrogenism. This is manifested by hyperandrogenemia and chronic anovulation.

Polycystic Ovary Syndrome is typified by formation of follicular cysts, which are detected by ultrasound. PCOS is a combination of polycystic ovaries and other typical symptoms like hirsutism, amenorrhea or dysfunctional uterine bleeding, infertility, obesity, irregular menstrual cycles and acne.

This is better diagnosed clinically rather than laboratory findings. The diagnosis of PCOS is based on exclusion, which means this disorder is attributed to patients whose body shows proof of ovulatory dysfunction supported by either clinical or biochemical evidence of hyperandrogenism.

PCOS is a broad scale disorder with patients ranging from women having regular cycles who have hirsutism to those people who are anovulatory.

Excess secretion by adrenal glands (Examples are congenital adrenal hyperplasia(CAH), cushing’s syndrome, tumors)

Congenital adrenal hyperplasia, or CAH, is a gamut of inherited disorders of adrenal steroidogenesis. In this case diminished cortisol production results in overproduction of androgenic steroids. The common symptoms are acne, menstrual dysfunctions, hirsutism occurring in adolescence or adulthood.

Cushing’s syndrome is caused by amplified production of adrenocorticotropic hormone (ACTH) by the pituitary, adrenal carcinoma/adrenoma or secretion of ectopic ACTH. The clinical symptoms of Cushing’s syndrome are quite evident. People with macronodular hyperplasia are common prey to intense hirsutism.

Ovarian or Adrenal Androgen secreting Tumors are rare triggers hirsutism/hyperandrogenism. These conditions are indicated by rapid virilization remote from menarche.

Exogenous pharmacologic sources of androgen

A person may suffer from Hirsutism as a result of using exogenous pharmacologic agents including testosterone, anabolic steroids and danazol (Danocrine).

Oral contraceptives containing norgestrel, levonorgestrel and norethindrone are predisposed to more powerful androgenic outcomes than those with norgestinate, desogestrel and ethynodiol diacetate, which have lesser androgenic effects.

Some rare causes of hirsutism

  • Medications: Hirsutism may be caused by the medications, which are the sources of hyperprolactinamia.
  • Greater production of growth hormones
  • Hyperinsulinemia
  • Hypothyroidism

The insight into the roots of hirsutism will accelerate the bold step forward, towards the cure of the disease.


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