Hirsutism: Signs of symptoms and causes

Describe

Unusually excessive hair growth, common in women who grow hair in a male fashion.

Hirsutism

Causes

Often met

Ovarian syndrome polycystic (PCOS - polycystic ovary syndrome) - the most common cause.

Cushing's syndrome.

Idiopathic.

Less common

Congenital adrenal proliferation.

Ovarian cysts.

Adrenal adenoma.

The proliferation of the inner shell cells of the ovaries - very rare.

Mechanism

Although there are many different causes, the common pathway of most mechanisms that cause hirsutism is over androgen excess. Androgens increase hair follicle size and hair diameter and prolong the hair growth phase. The most common androgens are testosterone, DHEA-S (dehydroepiandrosterone sulfate) and androstenedione.

Ovarian syndrome polycystic

Ovarian syndrome polycystic leading to androgen overproduction. The reason why is still being studied along with the mechanism of this syndrome itself. In the normal ovaries, LH stimulates the shell cells in the production of androgen and androgen precursors through a number of enzymes. In patients with ovarian syndrome polycystic, shell cells in androgens produce more efficiently. Excess androgen content increases hair follicle size and filament diameter and prolongs the growth phase.

Factors that contribute to increased androgen production in patients with ovarian syndrome polycystic:

Increased frequency of GnRH secretion, thereby increasing LH secretion rhythm.

Insulin (increased in ovarian syndrome polycysts) synergistically with LH increases androgen production.

Insulin also inhibits the sex-binding hormone globulin, the normal type of globulin that binds to testosterone, thereby increasing free or active testosterone.

Cushing's syndrome

The mechanism is unknown. Excessive increases in ACTH have been shown to increase the stimulation of the bundle layer (shingles fasciculata) and reticulum (shingles glomerulosa), thereby increasing cortisol and androgen secretion.

Congenital adrenal proliferation

In most forms of congenital adrenal hyperplasia, there is a deficiency of the enzyme 21-hydroxylase. This enzyme is required for the synthesis of aldosterone and mineralocorticoids from cholesterol. In the absence of this enzyme, the synthesis pathway is switched to androgen. Androgens stimulate shallow follicles and cause hirsutism

Adrenal tumor

A rare cause of androgens. Some types of testosterone secrete, but most secrete DHEA, DHEA-S and cortisol. In these cases, the patient may be masculinized and have severe hirsutism in various body sites (chest, back) and other affected areas.

Meaning

Meet in 60-70% of patients with Cushing's syndrome. Not specific to the pathology, and the majority of cases are idiopathic and benign.

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