Hirsutism

Hirsutism, the excessive growth of male-pattern hair in females, occurs in up to 8% of US women. Although one of the most common endocrinopathies for which women seek medical attention, hirsutism is one of the most diagnostically and therapeutically misunderstood disorders confronting today's primary care physician. In this article, Drs Schwartz and Flink seek to shed some light on this perplexing disorder.     

Hirsutism in women

Hirsutism is excess terminal hair that commonly appears in a male pattern in women. Although hirsutism is generally associated with hyperandrogenemia, one-half of women with mild symptoms have normal androgen levels. The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. Many medications can also cause hirsutism. In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such as polycystic ovary syndrome, adrenal hyperplasia, thyroid dysfunction, Cushing syndrome, and androgen-secreting tumors. Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass. Patients without these findings who have mild symptoms and normal menses can be treated empirically. For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if moderately elevated, it should be followed by a plasma free testosterone level. A total testosterone level greater than 200 ng per dL (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor. Further workup is guided by history and physical examination, and may include thyroid function tests, prolactin level, 17-hydroxyprogesterone level, and corticotropin stimulation test. Treatment includes hair removal and pharmacologic measures. Shaving is effective but needs to be repeated often. Evidence for the effectiveness of electrolysis and laser therapy is limited. In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives. Topical agents, such as eflornithine, may also be used. Treatment response should be monitored for at least six months before making adjustments.     

Hirsutism

Hirsutism is defined as the excessive growth of terminal hair on the face and body of a female in a typical male pattern distribution. Hirsutism is a common clinical problem in women and the treatment depends on the cause of hirsutism. Untreated hirsutism can be associated with considerable loss of self-esteem and psychological morbidity. Hyperandrogenemia is the key trigger for excess hair growth. Polycystic ovary syndrome and idiopathic hirsutism are the most common cause of hirsutism. As with all medical problems, investigation begins with a careful history, examination and then investigation directed at the possible cause. A raised serum testosterone level of > 150 ng/dl (5.2 nmol/l) should prompt further investigations to exclude an underlying androgen-secreting tumour. The treatment of hirsutism is most effective using combination therapy, including lifestyle therapies, androgen suppression, peripheral androgen blockage and cosmetic treatments. Women should be warned not to expect improvement or at least 3-6 months after therapy is begun and lifelong therapy may be needed to prevent recurrence. The current review discusses definition, pathogenesis, differential diagnosis, diagnostic strategies, management, guidelines and the authors' recommendations about hirsutism.     

Pretibial myxedema

Pretibial myxedema is a localized dermopathy seen in patients with past or present hyperthyroidism. Massive intradermal deposition of mucin (acid mucopolysaccharide) produces the classic indurated nodules or plaques on the anterior lower legs. Most patients have elevated levels of LATS in their serum; however, this appears to be a marker for the disease, rather than a cause. Mild pretibial myxedema requires no treatment. Topical, intralesional or systemic steroids may be useful in severe cases.     

Hirsutism: definitions and etiology

Hirsutism as a sign of hyperandrogenism is a common endocrinological disorder in women. Its spectrum varies from mild forms with dominating psychic component to severe forms associated with virilization. The severity should be assessed by semiobjective scoring systems, the use of which also allows the systematic follow-up of the results of treatment. An increase in serum androgen levels or an increased turnover of androgens can be detected in most patients. Enhanced peripheral conversion of androgens to locally acting androgen also leads to hirsutism. The thorough investigation of the endocrinological milieu is required to rule out androgen producing neoplasms. In most patient, however, disturbances are functional, among which polycystic ovary syndrome is the commonest. It is a disorder exhibiting a complexity of changes in endocrinological interactions. Besides inappropriate gonadotropin secretion insulin and insulin like growth factor are also involved. The opioidergic system also seems to be affected. Polycystic ovary syndrome is also associated with obesity and infertility, both of which require attention.     

Cardiac enzyme changes in myxedema coma

A 74-year-old man with myxedema and hypothermia had increased activities in plasma of creatine kinase (CK; EC 2.7.3.2), aspartate aminotransferase (AST; EC 2.6.1.1), and lactate dehydrogenase (LD; EC 1.1.1.27) and increased proportions of CK-MB (up to 20% of total CK) and LD1 isoenzymes, but no clinical or investigational evidence of associated myocardial infarction. This case illustrates that plasma enzyme activity and isoenzyme profiles in such clinical settings should be interpreted with caution, because increases in CK-MB and LD1 may relate to myxedema coma or hypothermia (or both) rather than to myocardial infarction.     

Secondary Amenorrhea,Infertility and Hirsutism

When a woman stops menstruating, becomes infertile, and grows unsightly body or facial hair, she probably has an adrenal or ovarian lesion. These two types of neoplasms can cause similar signs and symptoms, as shown by the case report of an arrhenoblastoma presented here. Special studies will differentiate an adrenal from an ovarian source, but diagnosis can be made only at laparotomy.     

胫前粘液性水肿的临床诊治

胫前粘液性水肿是Graves病的少见临床表现,其临床特征为双侧胫前或足背对称性非凹陷性皮肤增厚伴一个或多个皮肤硬结。胫前粘液性水肿是由于皮肤成纤维细胞在细胞因子的刺激下大量分泌的氨基葡聚糖（特别是透明质酸）在真皮内聚集所致,其发病机制可能与特异性识别TSH受体的抗体或T细胞所诱导的炎症刺激成纤维细胞合成氨基葡聚糖增多有关。Grave病患者维持正常的甲状腺功能、避免外伤、戒烟、减轻体重等可能对胫前粘液性水肿有一定的预防作用,皮下局部注射糖皮质激素或局部外用糖皮质激素软膏可有效缓解皮损,副作用小。     

Hirsutism: causes and treatment for women

Hirsutism is defined as an androgen-dependent, male pattern of hair distribution in women. It affects between 5-15% of all women across all ethnic backgrounds (Azziz, 2003). The presence of unwanted female facial hair (and male hair patterns in other body areas) is the devastating consequence of hirsutism. It is also estimated that up to 40% of the general female population have some degree of unwanted facial hair (Hamzavi et al, 2007). The treatment of hirsutism is twofold; treating the underlying cause and reducing visible hair. This article will seek to define the causes of hirsutism, explore current treatment options for the removal of unwanted hair and discuss the psychosocial effects for the woman with hirsutism.     

Thyroid storm and myxedema coma

This article describes the clinical recognition of, and pathophysiological mechanisms underlying the development of, thyroid storm and myxedema coma. Effective therapeutic management of these conditions depends on a clear understanding of the physiological adaptations occurring in hyperthyroidism and hypothyroidism, and of how precipitating events may produce these decompensated states.