Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Hirsutism

Hirsutism Abstract For the purposes of this editorial, we are restricting our definition of hirsutism to an excess of terminal hair in a pattern not normal in the female patient. Affected areas include the upper lip, cheeks, chin, back, thighs, upper part of the arms, and central parts of the chest and lower parts of the abdomen. Clinically notable hirsutism in the past has often been attributed to normal variation or a familial tendency, but the development of more sensitive assay techniques has disclosed that the majority of patients with hirsutism do have an underlying abnormality of androgen metabolism. Several well-referenced reviews describe androgen metabolism and its abnormalities in hirsutism.1-5 ANDROGENS In women, biosynthesis of androgenic steroids occurs only in the adrenal and the ovary. Ectopic neoplastic sources are unknown. Extraglandular conversions of androgenic precursors play an important role in their activation and function. Androgens differ from each other not only References 1. Givens JR: Hirsutism and hyperandrogenism . Adv Intern Med 1976;21:221-247. 2. Givens JR: Normal and abnormal androgen metabolism . Clin Obstet Gynecol 1978;21:115-123.Crossref 3. Kirschner MA: Hirsutism and virilization . Resident Staff Phys 1979;25:118-126. 4. Strickler RC, Warren JC: Hirsutism: Diagnosis and management , in Pitkin RM, Zlanik FJ (eds): Yearbook of Obstetrics and Gynecology . Chicago, Year Book Medical Publishers, 1979, pp 311-334. 5. Hatch R, Rosenfield RL, Kim MH, et al: Hirsutism: Implications, etiology, and management . Am J Obstet Gynecol 1981; 140:815-830. 6. Givens JR, Anderson RN, Wiser WL, et al: A gonadotropin-responsive adrenocortical adenoma . J Clin Endocrinol Metabol 1974;38:126-133.Crossref 7. Werk EE Jr, Sholiton LJ, Kalejs L: Testosterone-secreting adrenal adenoma under gonadotropin control . N Engl J Med 1973;289:767-770.Crossref 8. Korth-Schutz S, Levine LS, New MI: Dehydroepiandrosterone sulfate (DS) levels: A rapid test for abnormal adrenal androgen secretion . J Clin Endocrinol Metabol 1976;42:1005-1013.Crossref 9. Abraham GE, Maroulis GB, Buster JE, et al: Effect of dexamethasone on serum cortisol and androgen levels in hirsute patients . Obstet Gynecol 1976;47:395-402. 10. Maroulis GB, Manlimos FS, Abraham GE: Comparison between urinary 17-ketosteroids and serum androgens in hirsute patients . Obstet Gynecol 1977;49:454-458. 11. Abraham GE, Maroulis GB, Boyers SP, et al: Dexamethasone suppression test in the management of hyperandrogenized patients . Obstet Gynecol 1981;57:158-165. 12. Bardin CW, Lipsett, MB: Testosterone and androstenedione blood production rates in normal women and women with idiopathic hirsutism or polycystic ovaries . J Clin Invest 1967;46:891-902.Crossref 13. Kirschner MA, Jacobs JB: Combined ovarian and adrenal vein catheterization to determine the site(s) of androgen overproduction in hirsute women . J Clin Endocrinol Metabol 1971;33:199-209.Crossref 14. Kirschner MA, Zucker IR, Jespersen D: Idiopathic hirsutism: An ovarian abnormality . N Engl J Med 1976;294:637-640.Crossref 15. Rosenfield RL: Plasma testosterone-binding globulin and indexes of the concentration of unbound plasma androgens in normal and hirsute subjects . J Clin Endocrinol Metabol 1971; 32:717-728.Crossref 16. Vermeulen A, Stoica T, Verdonck L: The apparent free testosterone concentration: An index of androgenicity . J Clin Endocrinol Metabol 1971;33:759-767.Crossref 17. Rosenfield RL: Plasma free androgen patterns in hirsute women and their diagnostic implications . Am J Med 1979;66:417-421.Crossref 18. Thomas JP, Oake RJ: Androgen metabolism in the skin of hirsute women . J Clin Endocrinol Metabol 1974;38:19-22.Crossref 19. Horton R, Hawks D, Lobo R: 3-α, 17-β-androstanediol glucuronide in plasma: A marker of androgen action in idiopathic hirsutism . J Clin Invest 1982;69:1203-1206.Crossref 20. Blankstein J, Faiman C, Reyes FI, et al: Adult-onset familial adrenal 21-hydroxylase deficiency . Am J Med 1980;68:441-448.Crossref 21. Cathelineau G, Brerault JL, Fiet J, et al: Adrenocortical 11-β-hydroxylation defect in adult women with postmenarchial onset of symptoms . J Clin Endocrinol Metabol 1980;51:287-291.Crossref 22. Lobo RA, Goebelsmann U: Adult manifestation of congenital adrenal hyperplasia due to incomplete 21-hydroxylase deficiency mimicking polycystic ovarian disease . Am J Obstet Gynecol 1980;138:720-726. 23. Rosenfield RL, Rich BH, Wolfsdorf JI, et al: Pubertal presentation of congenital Δ-3-β-hydroxysteroid dehydrogenase deficiency . J Clin Endocrinol Metabol 1980;51:345-353.Crossref 24. Chrousos GP, Loriaux DL, Mann DL, et al: Late-onset 21-hydroxylase-deficiency mimicking idiopathic hirsutism or polycystic ovarian disease . Ann Intern Med 1982;96:143-148.Crossref 25. Krensky AM, Bongiovanni AM, Marino J, et al: Identification of heterozygote carriers of congenital adrenal hyperplasia by radioimmunoassay of serum 17-OH progesterone . J Pediatr 1977; 90:930-933.Crossref 26. Kim MH, Rosenfield RL, Hosseinian AH, et al: Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries . Am J Obstet Gynecol 1979;134:445-450. 27. Braithwaite SS, Erkman-Balis B, Avila TD: Postmenopausal virilization due to ovarian stromal hyperthecosis . J Clin Endocrinol Metabol 1978;46:295-300.Crossref 28. Yen SSC, Vela P, Rankin J: Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease . J Clin Endocrinol Metabol 1970;30:435-442.Crossref 29. Judd HL, McPherson RA, Rakoff JS, et al: Correlation of the effects of dexamethasone administration on urinary 17-ketosteroids and serum androgen levels in patients with hirsutism . Am J Obstet Gynecol 1977;128:408-417. 30. Lachelin GCL, Judd HL, Swanson SC, et al: Long-term effects of nightly dexamethasone administration in patients with polycystic ovarian disease . J Clin Endocrinol Metabol 1982;55:768-773.Crossref 31. Givens JR, Andersen RN, Wiser WL, et al: The effectiveness of two oral contraceptives in suppressing plasma androstenedione, testosterone, LH, and FSH, and in stimulating plasma testosterone-binding capacity in hirsute women . Am J Obstet Gynecol 1976; 124:333-339. 32. Carter JN, Tyson JE, Warne GL, et al: Adrenocortical function in hyperprolactinemic women . J Clin Endocrinol Metabol 1977;45:973-980.Crossref 33. Vermeulen A, Ando S: Prolactin and adrenal androgen secretion . Clin Endocrinol 1978;8:295-303.Crossref 34. Glickman SP, Rosenfield RL, Bergenstal RM, et al: Multiple androgenic abnormalities including elevated free testosterone, in hyperprolactinemic women . J Clin Endocrinol Metabol 1982; 55:251-257.Crossref 35. Kahn CR, Flier JS, Bar RS, et al: The syndromes of insulin resistance and acanthosis nigricans . N Engl J Med 1976;294:739-745.Crossref 36. DeOliverira RFC, Novaes LP, Lima MB, et al: A new treatment for hirsutism . Ann Intern Med 1975;83:817-819.Crossref 37. Wortsman J, Singh KB, Murphy J: Evidence for the hypothalamic origin of the polycystic ovary syndrome . Obstet Gynecol 1981;58:137-141. 38. Ettinger B, Golditch IM: Medroxyprogesterone acetate for the evaluation of hypertestosteronism in hirsute women . Fertil Steril 1977;28:1285-1288. 39. Vigersky RA, Mehlman I, Glass AR, et al: Treatment of hirsute women with cimetidine . N Engl J Med 1980;303:1042.Crossref 40. Ober KP, Hennessy JF: Spironolactone therapy for hirsutism in a hyperandrogenic woman . Ann Intern Med 1978;89:643-644.Crossref 41. Boisselle A, Tremblay RR: New therapeutic approach to the hirsute patient . Fertil Steril 1979;32:276-279. 42. Shapiro AV, Evron S: A novel use of spironolactone: Treatment of hirsutism . J Clin Endocrinol Metabol 1980;51:429-432.Crossref 43. Blum I, Kaufman H, Marilus R, et al: Successful treatment of polycystic ovary syndrome with spironolactone or bromocriptine . Obstet Gynecol 1981;57:661-665. 44. Evron S, Shapiro G, Diamant YZ: Induction of ovulation with spironolactone (Aldactone) in anovulatory aligomenorrheic and hyperandrogenic women . Fertil Steril 1981;36:468-471. 45. Cumming DC, Yang JC, Rebar RW, et al: Treatment of hirsutism with spironolactone . JAMA 1982;247:1295-1298.Crossref 46. Underhill R, Dewhurst J: Further clinical experience in the treatment of hirsutism with cyproterone acetate . Br J Obstet Gynecol 1979;86:139-141.Crossref 47. Frey H, Aakvaag A: The treatment of essential hirsutism in women with cyproterone acetate and ethinyl estradiol . Acta Obstet Gynecol Scand 1981;60:295-300.Crossref 48. Jones KR, Katz M, Keyzer C, et al: Effect of cyproterone acetate on rate of hair growth in hirsute females . Br J Dermatol 1981;105:685-692.Crossref 49. Kuttenn F, Rigaud C, Wright F, et al: Treatment of hirsutism by oral cyproterone acetate and percutaneous estradiol . J Clin Endocrinol Metabol 1980;51:1107-1111.Crossref 50. Ylostalo P, Laakso L, Viinikka L, et al: Cyproterone acetate in the treatment of hirsutism . Acta Obstet Gynecol Scand 1981; 60:339-401.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Loading next page...
 
/lp/american-medical-association/hirsutism-0xd03IIIX1

References (50)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1983.01650280007005
Publisher site
See Article on Publisher Site

Abstract

Abstract For the purposes of this editorial, we are restricting our definition of hirsutism to an excess of terminal hair in a pattern not normal in the female patient. Affected areas include the upper lip, cheeks, chin, back, thighs, upper part of the arms, and central parts of the chest and lower parts of the abdomen. Clinically notable hirsutism in the past has often been attributed to normal variation or a familial tendency, but the development of more sensitive assay techniques has disclosed that the majority of patients with hirsutism do have an underlying abnormality of androgen metabolism. Several well-referenced reviews describe androgen metabolism and its abnormalities in hirsutism.1-5 ANDROGENS In women, biosynthesis of androgenic steroids occurs only in the adrenal and the ovary. Ectopic neoplastic sources are unknown. Extraglandular conversions of androgenic precursors play an important role in their activation and function. Androgens differ from each other not only References 1. Givens JR: Hirsutism and hyperandrogenism . Adv Intern Med 1976;21:221-247. 2. Givens JR: Normal and abnormal androgen metabolism . Clin Obstet Gynecol 1978;21:115-123.Crossref 3. Kirschner MA: Hirsutism and virilization . Resident Staff Phys 1979;25:118-126. 4. Strickler RC, Warren JC: Hirsutism: Diagnosis and management , in Pitkin RM, Zlanik FJ (eds): Yearbook of Obstetrics and Gynecology . Chicago, Year Book Medical Publishers, 1979, pp 311-334. 5. Hatch R, Rosenfield RL, Kim MH, et al: Hirsutism: Implications, etiology, and management . Am J Obstet Gynecol 1981; 140:815-830. 6. Givens JR, Anderson RN, Wiser WL, et al: A gonadotropin-responsive adrenocortical adenoma . J Clin Endocrinol Metabol 1974;38:126-133.Crossref 7. Werk EE Jr, Sholiton LJ, Kalejs L: Testosterone-secreting adrenal adenoma under gonadotropin control . N Engl J Med 1973;289:767-770.Crossref 8. Korth-Schutz S, Levine LS, New MI: Dehydroepiandrosterone sulfate (DS) levels: A rapid test for abnormal adrenal androgen secretion . J Clin Endocrinol Metabol 1976;42:1005-1013.Crossref 9. Abraham GE, Maroulis GB, Buster JE, et al: Effect of dexamethasone on serum cortisol and androgen levels in hirsute patients . Obstet Gynecol 1976;47:395-402. 10. Maroulis GB, Manlimos FS, Abraham GE: Comparison between urinary 17-ketosteroids and serum androgens in hirsute patients . Obstet Gynecol 1977;49:454-458. 11. Abraham GE, Maroulis GB, Boyers SP, et al: Dexamethasone suppression test in the management of hyperandrogenized patients . Obstet Gynecol 1981;57:158-165. 12. Bardin CW, Lipsett, MB: Testosterone and androstenedione blood production rates in normal women and women with idiopathic hirsutism or polycystic ovaries . J Clin Invest 1967;46:891-902.Crossref 13. Kirschner MA, Jacobs JB: Combined ovarian and adrenal vein catheterization to determine the site(s) of androgen overproduction in hirsute women . J Clin Endocrinol Metabol 1971;33:199-209.Crossref 14. Kirschner MA, Zucker IR, Jespersen D: Idiopathic hirsutism: An ovarian abnormality . N Engl J Med 1976;294:637-640.Crossref 15. Rosenfield RL: Plasma testosterone-binding globulin and indexes of the concentration of unbound plasma androgens in normal and hirsute subjects . J Clin Endocrinol Metabol 1971; 32:717-728.Crossref 16. Vermeulen A, Stoica T, Verdonck L: The apparent free testosterone concentration: An index of androgenicity . J Clin Endocrinol Metabol 1971;33:759-767.Crossref 17. Rosenfield RL: Plasma free androgen patterns in hirsute women and their diagnostic implications . Am J Med 1979;66:417-421.Crossref 18. Thomas JP, Oake RJ: Androgen metabolism in the skin of hirsute women . J Clin Endocrinol Metabol 1974;38:19-22.Crossref 19. Horton R, Hawks D, Lobo R: 3-α, 17-β-androstanediol glucuronide in plasma: A marker of androgen action in idiopathic hirsutism . J Clin Invest 1982;69:1203-1206.Crossref 20. Blankstein J, Faiman C, Reyes FI, et al: Adult-onset familial adrenal 21-hydroxylase deficiency . Am J Med 1980;68:441-448.Crossref 21. Cathelineau G, Brerault JL, Fiet J, et al: Adrenocortical 11-β-hydroxylation defect in adult women with postmenarchial onset of symptoms . J Clin Endocrinol Metabol 1980;51:287-291.Crossref 22. Lobo RA, Goebelsmann U: Adult manifestation of congenital adrenal hyperplasia due to incomplete 21-hydroxylase deficiency mimicking polycystic ovarian disease . Am J Obstet Gynecol 1980;138:720-726. 23. Rosenfield RL, Rich BH, Wolfsdorf JI, et al: Pubertal presentation of congenital Δ-3-β-hydroxysteroid dehydrogenase deficiency . J Clin Endocrinol Metabol 1980;51:345-353.Crossref 24. Chrousos GP, Loriaux DL, Mann DL, et al: Late-onset 21-hydroxylase-deficiency mimicking idiopathic hirsutism or polycystic ovarian disease . Ann Intern Med 1982;96:143-148.Crossref 25. Krensky AM, Bongiovanni AM, Marino J, et al: Identification of heterozygote carriers of congenital adrenal hyperplasia by radioimmunoassay of serum 17-OH progesterone . J Pediatr 1977; 90:930-933.Crossref 26. Kim MH, Rosenfield RL, Hosseinian AH, et al: Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries . Am J Obstet Gynecol 1979;134:445-450. 27. Braithwaite SS, Erkman-Balis B, Avila TD: Postmenopausal virilization due to ovarian stromal hyperthecosis . J Clin Endocrinol Metabol 1978;46:295-300.Crossref 28. Yen SSC, Vela P, Rankin J: Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease . J Clin Endocrinol Metabol 1970;30:435-442.Crossref 29. Judd HL, McPherson RA, Rakoff JS, et al: Correlation of the effects of dexamethasone administration on urinary 17-ketosteroids and serum androgen levels in patients with hirsutism . Am J Obstet Gynecol 1977;128:408-417. 30. Lachelin GCL, Judd HL, Swanson SC, et al: Long-term effects of nightly dexamethasone administration in patients with polycystic ovarian disease . J Clin Endocrinol Metabol 1982;55:768-773.Crossref 31. Givens JR, Andersen RN, Wiser WL, et al: The effectiveness of two oral contraceptives in suppressing plasma androstenedione, testosterone, LH, and FSH, and in stimulating plasma testosterone-binding capacity in hirsute women . Am J Obstet Gynecol 1976; 124:333-339. 32. Carter JN, Tyson JE, Warne GL, et al: Adrenocortical function in hyperprolactinemic women . J Clin Endocrinol Metabol 1977;45:973-980.Crossref 33. Vermeulen A, Ando S: Prolactin and adrenal androgen secretion . Clin Endocrinol 1978;8:295-303.Crossref 34. Glickman SP, Rosenfield RL, Bergenstal RM, et al: Multiple androgenic abnormalities including elevated free testosterone, in hyperprolactinemic women . J Clin Endocrinol Metabol 1982; 55:251-257.Crossref 35. Kahn CR, Flier JS, Bar RS, et al: The syndromes of insulin resistance and acanthosis nigricans . N Engl J Med 1976;294:739-745.Crossref 36. DeOliverira RFC, Novaes LP, Lima MB, et al: A new treatment for hirsutism . Ann Intern Med 1975;83:817-819.Crossref 37. Wortsman J, Singh KB, Murphy J: Evidence for the hypothalamic origin of the polycystic ovary syndrome . Obstet Gynecol 1981;58:137-141. 38. Ettinger B, Golditch IM: Medroxyprogesterone acetate for the evaluation of hypertestosteronism in hirsute women . Fertil Steril 1977;28:1285-1288. 39. Vigersky RA, Mehlman I, Glass AR, et al: Treatment of hirsute women with cimetidine . N Engl J Med 1980;303:1042.Crossref 40. Ober KP, Hennessy JF: Spironolactone therapy for hirsutism in a hyperandrogenic woman . Ann Intern Med 1978;89:643-644.Crossref 41. Boisselle A, Tremblay RR: New therapeutic approach to the hirsute patient . Fertil Steril 1979;32:276-279. 42. Shapiro AV, Evron S: A novel use of spironolactone: Treatment of hirsutism . J Clin Endocrinol Metabol 1980;51:429-432.Crossref 43. Blum I, Kaufman H, Marilus R, et al: Successful treatment of polycystic ovary syndrome with spironolactone or bromocriptine . Obstet Gynecol 1981;57:661-665. 44. Evron S, Shapiro G, Diamant YZ: Induction of ovulation with spironolactone (Aldactone) in anovulatory aligomenorrheic and hyperandrogenic women . Fertil Steril 1981;36:468-471. 45. Cumming DC, Yang JC, Rebar RW, et al: Treatment of hirsutism with spironolactone . JAMA 1982;247:1295-1298.Crossref 46. Underhill R, Dewhurst J: Further clinical experience in the treatment of hirsutism with cyproterone acetate . Br J Obstet Gynecol 1979;86:139-141.Crossref 47. Frey H, Aakvaag A: The treatment of essential hirsutism in women with cyproterone acetate and ethinyl estradiol . Acta Obstet Gynecol Scand 1981;60:295-300.Crossref 48. Jones KR, Katz M, Keyzer C, et al: Effect of cyproterone acetate on rate of hair growth in hirsute females . Br J Dermatol 1981;105:685-692.Crossref 49. Kuttenn F, Rigaud C, Wright F, et al: Treatment of hirsutism by oral cyproterone acetate and percutaneous estradiol . J Clin Endocrinol Metabol 1980;51:1107-1111.Crossref 50. Ylostalo P, Laakso L, Viinikka L, et al: Cyproterone acetate in the treatment of hirsutism . Acta Obstet Gynecol Scand 1981; 60:339-401.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 1983

There are no references for this article.