Hirsutism

Introduction to hirsutism Hypertrichosis generally refers to excessive growth and abnormal distribution of female hair. It is the accumulation of androgen in the blood circulation including testosterone, dihydrotestosterone, androstenedione, dehydroepiandrosterone and dehydroepiandrosterone sulfate. Clinically, female sexual characteristics may have excessive hair growth and the distribution is masculine. Mainly manifested in the face, front of the ear, around the mouth, chest, around the nipple, armpit, back, lower abdomen, pubic hair more dense, diamond-shaped distribution to the umbilicus, and the lower extremities and the front of the thigh, often accompanied by irregular menstruation, cold Etc., female hairy is often considered to have some kind of masculine disease, and there is psychological pressure to seek treatment. basic knowledge The proportion of illness: 0.001% Susceptible people: good for women Mode of infection: non-infectious Complications: endocrine disorders Cushing's syndrome Polycystic ovary syndrome

Cause of hirsutism

Causes

Congenital factors (20%):

It includes home hirsutism, premature development, male malformation and primary hirsutism. Primary hirsutism is caused by hair follicles allergic to endogenous androgen or increased dihydrohydrotestosterone.

Drug factors (20%):

Because of the use of exogenous drugs (such as androgen, phenytoin, synthetic progesterone, cortisone), pregnancy, mental anorexia, mental stress or local irritations caused by hirsutism.

Brain lesions (10%):

Such as encephalitis, multiple sclerosis and hirsutism caused by intracranial plate hyperplasia.

Endocrine factors (30%):

1. Acromegaly, diabetes, basophilic tumor (secondary hypercortisolism) may cause hirsutism. 2. Juvenile thyroid dysfunction caused by hirsutism. 3. Adrenal glandular syndrome and hirsutism caused by hypercortisolism. 4. Menopausal or women with polycystic ovary or follicular hyperplasia and ovarian tumors, will be more hairy. Among many reasons, adrenal adenomas, ovarian tumors, polycystic ovary, follicular hyperplasia, and primary hirsutism are the most common.

Pathogenesis

1. Familial hereditary hirsutism hirsutism may be caused by elevated plasma testosterone levels, or testosterone is converted to dihydrotestosterone in hair follicles. In female patients with familial hereditary hirsutism, the body hair is slightly smaller than normal. More, thin and long, distributed as male, may be hair follicles are more sensitive to androgen, receptors are rich, the normal amount of androgen in the body or exogenous low-dose androgen can cause hirsutism.

2. Adrenal hirsutism

(1) Adrenal tumor: adrenal adenoma or adrenocortical carcinoma, can synthesize excessive secretion of androstenedione, dehydroepiandrosterone and testosterone and other androgens, resulting in hirsutism and masculinization.

(2) Cushing's disease: increased ACTH secretion causes bilateral adrenal hyperplasia, hypercortisolism, ACTH is mostly derived from pituitary basophils or chromophobe cells, less from ectopic ACTH syndrome, ie In some malignant tumors such as lung cancer, adrenal hyperplasia often secretes the growth of adrenal androgen, which causes female amenorrhea, hairy and masculine performance.

(3) masculinization of congenital adrenal hyperplasia: adrenal P450 C2l-hydroxylase deficiency, P450 C11-hydroxylase deficiency and 3-HSD deficiency, adrenal cortisol synthesis disorders and reduction, can cause ACTH compensatory secretion Increased, leading to excessive androgen secretion and adrenal hyperplasia, young female patients may have varying degrees of hirsutism and masculine manifestations, that is, amenorrhea, abnormal laryngeal appearance and low sound.

3. Central hirsutism

(1) cerebral hirsutism: after brain damage such as encephalitis, multiple sclerosis, pineal tumor and intracranial hyperplasia, some patients may have increased androgen secretion, and induced hirsutism.

(2) hypothalamic and pituitary hirsutism: hypothalamic and pituitary tumors, pituitary eosinophilic adenoma, basophil hyperplasia and adenoma, etc., can cause adrenal hyperplasia, and cause hirsutism, acromegaly Symptoms can also have hirsutism.

4. Ovarian hirsutism

(1) Polycystic ovary syndrome: is the cause of more common hirsutism, may be associated with clitoris hypertrophy, due to aromatase in polycystic ovary, 3-hydroxysteroid dehydrogenase inhibition and P450C, 17 and 20-cleavage The enzymatic activity is enhanced to cause the proliferation of the ovarian follicle cells, and the synthesis of androgens is increased to cause hirsutism and masculinity.

(2) ovarian tumors: such as ovarian germ cell tumor, portal cell tumor, ovarian cord tumor and adrenal residual cell tumor can synthesize and secrete androgen, causing hirsutism and masculinity.

5. Drug-induced hirsutism Some drugs such as phenytoin, diazoxide, minoxidil and cyclosporine in non-hormonal drugs, hormone drugs such as prednisone, etc. take too long, when the dose is large Can cause hirsutism.

6. Insulin resistance syndrome and hirsutism Insulin resistance receptor deficiency causes three types of insulin resistance syndrome: 1 insulin resistance type A, its clinical manifestations are mostly diabetes, acanthosis nigricans and androgen levels. 2 adipose atrophic diabetes may have diabetes, lipoatrophy, elevated triglycerides, elevated acanthosis nigricans and androgen levels. 3 Dwarfism manifested as stagnation in intrauterine growth, fasting hypoglycemia, dwarfism and elevated androgen levels. These hyperinsulinemia can cause follicular cell proliferation and excessive secretion and secretion of androgen. Symptoms and masculine performance.

7. Idiopathic hirsutism is more common in clinical practice. The patient has no genetic family history, no organic disease, no medication history, and the main manifestations of hirsutism can not find the cause, and the examination is normal. It belongs to idiopathic hirsutism.

Hirsutism prevention

The onset and progression of hirsutism have other aggravating factors. These factors can aggravate the symptoms of hirsutism, and can also bring many complications, and directly affect the treatment and recovery of hirsutism. Pay attention to the following considerations:

1. The mood is not comfortable, there are long-term anger and depression, anxiety, anxiety and other negative emotional stimuli.

2. The diet structure is unreasonable. There are bad habits of eating greasy, spicy food and excessive drinking, and many are accompanied by long-term constipation.

3. The rhythm of life is disordered and there is a long history of staying up late.

4. Inappropriate care for skin and hair, use cosmetics or toiletries that are not suitable for your own conditions.

5. Treatment errors, incorrect extraction, hair removal methods or excessively frequent pulling and hair removal.

Porral complication Complications, endocrine disorders, Cushing's syndrome, polycystic ovary syndrome

Female masculinity.

Symptoms of hirsutism Common symptoms Acne excessive ovarian hair loss Hair loss and high androgenemia Skin greasy pregnancy occurs in the hairy male Cushing syndrome lumbosacral skin hairy... 21-hydroxylase deficiency

The most sensitive sign of androgen production is hairy, then acne, oily skin, increased libido, clitoris hypertrophy, and finally masculine, masculine more suggestive of tumors, acne is another sign of androgen excess, although Many patients with acne have low testosterone levels, but there is evidence of increased 5-reductase. Hair loss is also one of the clinical manifestations. 40% of off-patients have hyperandrogenism.

Patients with hyperandrogenism should pay special attention to the presence of acanthosis nigricans.

The hairy hair that occurs during pregnancy is often caused by flavin tumors and disappears after delivery. The only danger is that it may lead to masculinization of female fetuses. There is very little chance of pregnancy with ovarian functional tumors, because the latter itself is not easy to get pregnant. .

Examination of hirsutism

Testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and DHEAS should be checked first. Free testosterone (FT), 17-hydroxyprogesterone Check, first observe whether T is elevated, the initial consideration is adrenal or ovarian, if LH is elevated or the ratio of LH to FSH is increased, it may be polycystic ovary syndrome, if the DHEAS is elevated, often adrenal . The normal T of DHEAS is obviously elevated, mostly ovarian. It is best to check PRL at the same time to exclude anovulatory caused by high prolactin. If the hairy is progressing rapidly, the tumors with androgen secretion should be considered, and the total T level is higher than 7nmol. /L (200ng/dl).

1. B-ultrasound examination of ovarian tumors can be found basically, ovarian enlargement or polycystic ovary can also be found, but the diagnosis rate of adrenal diseases is lower.

2. CT or MRI is very sensitive to adrenal tumors, and can also be located, but also can show the contralateral adrenal gland, but sometimes adrenal hyperplasia will be misdiagnosed, and the diagnosis of ovarian tumors is also of great value.

3. Laparoscopy If there is no abnormality in the non-invasive examination, and the laboratory examination is highly suggestive of ovarian tumors (such as total T>7mmol/L), laparoscopic diagnosis should be performed, and preparation for laparoscopic resection of the tumor should be done. .

Diagnosis of hirsutism

diagnosis

When asking about medical history and physical examination, attention should be paid to the degree of hairiness and the rate of hairy development. It is related to tumors. It should also pay attention to whether there are acromegaly and other manifestations of Cushing's syndrome, and should pay special attention to the history of medication: Danazol may also contain a small amount of androgen in combination preparations for menopausal syndrome, such as phenytoin, minoxidil, chlorpromazine and diazoxide.

For patients with hairy hair, special attention should be paid to menstrual problems. For young women, long-term irregular menstruation and slow progression of hairy hair, the most likely diagnosis is ovarian hairiness caused by anovulation.

Differential diagnosis

1, should be associated with polycystic ovary syndrome, adrenal hyperplasia, adrenal adenoma, adrenal cortical cancer, ovarian tumors and ectopic ACTH syndrome.

Such as polycystic ovary syndrome, there may be obesity, amenorrhea, infertility, clitoris hypertrophy, hemorrhoids, breast dysplasia and hirsutism and other symptoms and signs.

Such as adrenal adenoma hirsutism, there may also be centripetal obesity, high blood pressure, hemorrhoids, amenorrhea, multi-blood, skin purple, full moon face and osteoporosis, etc., its cortisol levels increased, urine 17- Increased KS and 17-OHCS and elevated urinary cortisol can be used for differential diagnosis.

Less common congenital adrenal hyperplasia is more easily recognized by adolescents, while delayed and insidious patients are more likely to develop after puberty, allele mutations, clinical manifestations only hairy and clitoris mild hypertrophy, it is not easy to Differential diagnosis of idiopathic hirsutism.

2, in addition to excessive hair identification, excessive hair refers to increased body surface hair, most have a history of excessive hair properties, there is no masculine performance, because there is no physiological abnormalities, so no treatment is needed.

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