HIRSUTISM AND VIRILISM

Question 1

What is hirsutism?

Answer 1

Excessive hairiness in a woman in those parts in which hair growth is normally either absent or minimal. Eg beard or chest hair.

Question 2

What are the features of hirsutism with virilism in women?

Answer 2

Excessive hair growth

Clitoral hypertrophy

Breast atrophy

Deepening of voice

Male pattern balding

Question 3

What percentage of healthy women are said to have a degree of hirsutism with or without virilism?

Answer 3

10%

Question 4

Are virilism and hirsutism independent (ie one does not necessarily come with the other)?

Answer 4

Hirsutism can occur without virilism, however, virilism does not tend to occur without hirsutism (apart from in neonates)

Question 5

What are the causes of hirsutism?

Answer 5

Idiopathic

Adrenal:
Congenital adrenal hyperplasia
Cushing’s syndrome

Ovarian:
PCOS

Iatrogenic:
Androgens
Anabolic steroids
Danazol
Norethisterone
Phenytoin

Question 6

What are the causes of virilism with hirsutism?

Answer 6

Never idiopathic

Adrenal:
Congenital adrenal hyperplasia
Cushing’s syndrome

Ovarian:
Tumours
Arrhenoblastomas
Hiler cells
Pregnancy luteomas

Iatrogenic:
Androgens
Anabolic steroids
Danazol

Question 7

What is the most common cause of hirsutism?

Answer 7

PCOS

Question 8

What are the features seen on examination of a patient with PCOS?

Answer 8

Obesity

Acanthosis nigricans

Hirsutism

Acne

Question 9

What are the features seen on examination a patient with congenital adrenal hyperplasia?

Answer 9

Obesity

Hirsutism/virilism

Ambiguous external genitalia in severe cases

Question 10

What are the features seen on examination of a patient with Cushing’s syndrome?

Answer 10

Hirsutism/virilism

Central obesity

Peripheral muscle atrophy

Hypertension

Striae

Question 11

What are the features seen on examination of a patient with an androgen producing tumour?

Answer 11

Hirsutism/virilism

Very little in terms of systemic upset

Often no masses felt

Question 12

How can we treat idiopathic hirsutism?

Answer 12

Bleaching

Electrolysis

Psychological support

Question 13

How do you treat hirsutism associated with PCOS?

Answer 13

Encourage weight loss

Medical treatment is a combination of Ethinyloestradiol and an anti-androgen such as cyproterone acetate

Metformin has also been shown to help with all features of PCOS, as recent evidence insulin resistance is a causative factor rather than just a complication.