Diagnostic evaluation of patients presenting with hirsutism

Abstract

Objective: Hirsutism, similar to men, is the presence of terminal hairs in androgen-to sensitive areas in women. The present report aimed to study etiology and determine the prevalence of the diseases that causes hirsutism in these patients. Methods: In this study, total number of 40 patients who admitted because of hirsutism to Department of Endocrinology and Metabolism clinic was enrolled. Demographic, clinical and laboratory parameters of the patients were evaluated. Results: Result of the study showed that polycystic ovary syndrome is the most common cause of hirsutism. The second most common cause was found as idiopathic hirsutism. Conclusion: By the present study, etiologic factors of hirsutism were examined firstly in our region in which Ethnic and cultural diversity is concentrated. In rare cases like Cushing's syndrome, hyperprolactinemia, non-classic adrenal hyperplasia, androgen-secreting tumors should be considered in the differential diagnosis of hirsutism. J Clin Exp Invest 2014; 5 (1): 69-75

Keywords

• Hirsutism, polycystic ovary syndrome, idiopathic

Hirsutizm nedeniyle başvuran hastaların tanısal açıdan değerlendirilmesi

Abstract

Amaç: Hirsutizm, kadınlarda androjen duyarlı bölgelerde erkeklerdekine benzer şekilde terminal kılların bulunmasıdır. Çalışmamızda hirsutizm şikayeti olan hastalarda etyolojiye yönelik araştırma yaparak hirsutizme neden olan hastalıkların sıklığının belirlenmesi amaçlanmıştır. Yöntemler: Çalışmaya Mustafa Kemal Üniversitesi Tıp Fakültesi Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı polikliniğine hirsutizm nedeniyle başvuran 40 hasta alındı. Hastalarla ilgili demografik, klinik ve laboratuvar parametreler incelendi. Bulgular: Çalışma sonucu hirsutizmin en sık nedeninin polikistik over sendromu olduğunu göstermiştir. İkinci en sık neden idiopatik hirsutizm bulunmuştur. Sonuç: Bu çalışmayla birlikte etnik ve kültürel farklılığın yoğun olduğu bölgemizde ilk olarak hirsutizmin etyolojik faktörleri incelenmiştir. Cushing sendromu, hiperprolaktinemi, non klasik adrenal hiperplazi, androjen salgılayan tümörler gibi nadir görülen durumlarda hirsutizmin ayrıcı tanısında düşünülmelidir.

Keywords

• Hirsutizm, polikistik over sendromu, idiyopatik

References

1. Somani N, Harrison S, Bergteld WF. The clinical evalu- ation of hirsutism. Dermatol Ther 2008;21:376-391.
2. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440-1447.
3. Price VH. Testosterone metabolism in the skin. Arch Dermatol 1975;111:1496-1502.
4. Azziz R, Carmina E, Sawaya ME. İdiopathic hirsutizm. Endocr Rev 2000;21: 347-362.
5. Keleştimur F. Hirsutism of adrenal origin in adoles- cents: Consequences in adults. J Ped Endocrinol Me- tabol 2001;14:1309-1315.
6. Nelson-DeGrave VL, Wickenheisser JK, Coc-krell JE, et al. Valproate potentiates androgen biosyn- thesis in human ovarian theca cells. Endocrinology 2004;145:799-808.
7. Yıldız BO. Diagnosis of hyperandrogenism: clini- cal criteria. Best Pract Res Clin Endocrinol Metab 2006;20:167-176.
8. Rosenfield RL. Hirsutism. N Engl J Med 2005;353:2578- 2588.

9. Kaltsas GA, Isidori AM, Kola BP, et al. The value of the low-dose dexamethasone suppression test in the dif- ferential diagnosis of hyperandrogenism in women. J Clin Endocrinoi Metab 2003;88:2634-2643.
10. Nikolaou D, Gilling-Smith C. Hirsutism. Cur Obstet Gynecol 2005;15:174-182.
11. Deplewski D, Rosenfield RL. Role of hormones in pilosebaceous unit development. Endocr Rev 2000;21:363-392.
12. Rosenfield RL. Plasma testosterone binding globulin and indexes of the concentration of inbound plasma androgens in normal and hirsute subjects. J Clin En- docrinol Metab 1971;32:717-726.
13. Moran C, Tapia MDC, Hernandez E, et al. Etiologic review of hirsutism in 250 patients. Arch Med Res 1994;25:311-314.
14. Glickman SP, Rosenfield RL. Androgen metabolism by isolated hairs from women with idiopathic hirsutism is usually normal. J Invest Dermatol 1984;82:62-66.
15. Azziz R, Sanchez LA, Knochenhauer ES., et al. An- drogen excess in women: experience with over 1000 consecutive patients. J Clin Endodocrinol excess. N Engl J Med 1992;327:157-162.
16. Isik AZ, Gulekli B. Zorlu CG, et al. Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes. Gynecol Obstet Invest 1997;43:183- 185.
17. Unluhizarcı K, Gökce C, Atmaca H. et al. A detailed investigation of hirsutism in a Turkish population: Idıopathic Hyperandrogenemia is a perplexing issue. Exp Clin Endocrinol Diabetes 2004;112:504-509.
18. Habib A, Mir-Hadi AJ, Abbas R, Razieh S. Archives of iranian Medicine 2007; 10:7-13.
19. Azziz R, Woods KS, Reyna R, et al. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-2749.
20. Mithal A, Ammini AC, Godbole MM, et al. Late-onset adrenal hyperplasia in North Indian hirsut woman. Horm Res 1988;30:1-4.
21. Zargar AH, Wani AI, Masoodi SR, et al. Epidemiyologic and etiologic aspects of hirsutism in Kashmiri women in the Indian subcontinent. Fertil Steril 2002;77:674- 678.
22. Kaltsas GA, Isidori AM, Besser GM, Grossman AB. Secondary forms of polycystic ovary syndrome. Trends Endocrinol Metab 2004;15:204-210.
23. Lobo RA, Carmina E. The importance of diagnos- ing the polycystic ovary syndrome. Ann Intern Med 2000;132:989-993.
24. Rotterdam ESHRE/ASRM-Sponsored PCOS Con- sensus Workshop Group. Revised 2003 consen- sus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
25. Fauser BC, Pache TD, Lamberts SW, et al. Serum bioactive and İmmunoreactive LH and FSH levels in women with cycle abnormalities, with or without PCOD. J Clin Endocrinol Metab 1991;73:811-817.
26. Waldstreicher J, Santoro NF, Hall HJE, et al. Hyper- function of the hypothalamic-pituitary axis in women with polycystic ovarian disease: indirect evidence of partial gonadotroph desensitization. J Clin Endocrinol Metab 1997;82:2248-2456.
27. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-1174.
28. Franks S, Gilling-Smith C. Ovary. In: Besser GM, Thorner MO (eds), Comprehensive clinical endocri- nology (3rd ed) Elsevier Science, London 2002:375- 393.
29. Legro RS, Finegood D, Dunaif A. A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endo- crinol Metab 1998;83:2694-2698.
30. Ehrmann DA, Barnes RB, Rosenfield RL, et al. Preva- lence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 1999;22:141-146.
31. Ünlühizarci K, Çolak R, Şahin Y, et al. The prevalence of glucose intolerance in women with polycystic ovary syndrome. Turk J Endocrinol Metab 2000;4:135-137.
32. Keleştimur F, Çetin M, Pasaoglu H, et al. The preva- lence and idenditification of risk factors for type 2 diabetes mellitus and impaired glucose intolerance in Kayseri, Central Anatolia, Turkey. Acta Diabetol 36:85-91.
33. Romaquera J, Moran C, Diaz-Montes TP, et al. Preva- lence of 21-hydroxylase deficient nonclassic adrenal hyperplasia and insulin resistance among hirsute women from Puerto Rico. Fertil Steril 2000;74:59-62.
34. Kutten F, Couillin P, Girard F, et al. Late onset adrenal hyperplasia inhirsutism. N Eng J Med 1985;313:224- 231.
35. Speiser PW, Dupont B, Rubinstein P, et al. High fre- quency of nonclassical steroid 21-hydroxylase defi- ciency. Am J Hum Genet 1985;37:650-667.
36. Akinci A, Yordam N, Ersoy F, et al. The incidence of non-classical 21-hydroxylase deficiency in hirsute adolescent girls. Gynecol Endocrinol 1992;6:99-106.
37. Azziz R, Dewailly D, Owerbach D. Non-classic adre- nal hyperplasia: Current concepts, J Clin Endocrinol Metab 1994;78:810-815.
38. Azziz R, Hincapie LA, Knochenhauer ES, et al. Screening 21-hydroxylase-deficient nonclasic adrenal hyperplasia among hyperandrogenic women: a pro- spective study. Fretil Steril 1999;72:915-925.
39. Saygili F, Oge A, Candeger Y, The ratio of late-onset congenital adrenal hyperplasia among women with hirsutism admitted to Ege University endocrinology outpatient clinic Ege Tıp Dergisi 2004;43:159-163.
40. Kamel N, Tonyukuk V, Emral R, et al. The prevalence of late onset congenital adrenal hyperplasia in hir- sute women from central Anatolia. Endocrine Journal 2003;50:815-823.
41. White PC. Congenital adrenal hyperplasia Endocrinol Metab Clin N Am 2001;30:61-79.
42. Isik AZ, Gulekli B, Zorlu CG, et al. Endocrinological and clinical analysis of hyperprolactinemic patients with and without ultrasonically diagnosed polycystic ovarian changes. Gynecol Obstet Invest 1997;43:183- 185.
43. Glasow A, Breidert M, Haidan A, et al. Functional aspects of the effect of prolactin (PRL) on adrenal steroidogenesis and distribution of the PRL receptor in the human adrenal gland. J Clin Endocrinol Metab 1996;81:3103-3111.
44. Kaltsas GA, Korbonits M, Isidori AM, et al. How com- mon are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing’s syndrome. Clin Endocrinol (Oxf) 2000;53:493-500.