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Margaret Wingate, LE
Lesa M. Wingate, LE AE
Lucia Haywood, LE

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HIRSUTISM

Types of Hirsutism

  • Idiopathic Hirsutism: The diagnosis of idiopathic hirsutism is given to women with normal serum androgen concentrations, no menstrual irregularity, and no identifiable cause of the hirsutism. In some women, there may be a steroidogenic abnormality despite the apparently normal serum androgen levels.

 

  • Nonclassic Congenital Adrenal Hyperplasia: Excess androgen production is a key feature of most forms of congenital adrenal hyperplasia. These disorders are usually recognized at birth or in early infancy, but nonclassic (also called late-onset) forms have been identified. Affected women present peripubertally with hirsutism and sometimes menstrual irregularity or primary amenorrhea; they have no manifestations of cortisol deficiency.

 

  • Androgen Secreting Tumor: Women with virilization or severe hyperandrogenemia – virilization of recent onset and rapid progression, a serum total testosterone >150ng/dl (5.2 nmol/L), or a serum DHEAS >700 to 800 mcg/dL (18.9 to 21.7 micromol/L) is usually due to an androgen-secreting tumor (ovarian or adrenal). Hirsutism caused by an androgen-secreting tumor usually occurs later in life and progresses rapidly when compared with PCOS. Androgen-secreting tumors constitute only 5 percent of all ovarian tumors.

 

  • Ovarian Hyperthecosis: Ovarian hyperthecosis is a nonmalignant ovarian disorder characterized by increased production of testosterone by luteinized thecal cells in the stroma, leading to markedly increased serum testosterone concentrations. It is still unclear if hyperthecosis is a distinct disorder or is a part of the spectrum of PCOS. The woman’s history is usually one of gradual onset of hirsutism and frank virilization. Hyperthecosis is seen primarily in postmenopausal women, but it can also occur in premenopausal women.