Chapter 050. Hirsutism and Virilization (Part 1)

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Harrison's Internal Medicine Chapter 50. Hirsutism and Virilization Hirsutism and Virilization: Introduction Hirsutism, defined as excessive male-pattern hair growth, affects approximately 10% of women. It usually represents a variation of normal hair growth, but rarely it is a harbinger of a serious underlying condition. Hirsutism is often idiopathic but may be caused by conditions associated with androgen excess, such as polycystic ovarian syndrome (PCOS) or congenital adrenal hyperplasia (CAH) (Table 50-1). Cutaneous manifestations commonly associated with hirsutism include acne and male-pattern balding (androgenic alopecia). ...

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Chapter 050. Hirsutism and Virilization (Part 1) Harrison's Internal Medicine > Chapter 50. Hirsutism and Virilization Hirsutism and Virilization: Introduction Hirsutism, defined as excessive male-pattern hair growth, affects approximately 10% of women. It usually represents a variation of normal hair growth, but rarely it is a harbinger of a serious underlying condition. Hirsutism is often idiopathic but may be caused by conditions associated with androgen excess, such as polycystic ovarian syndrome (PCOS) or congenital adrenal hyperplasia (CAH) (Table 50-1). Cutaneous manifestations commonly associated with hirsutism include acne and male-pattern balding (androgenic alopecia).
Virilization refers to a condition in which androgen levels are sufficiently high to cause additional signs and symptoms such as deepening of the voice, breast atrophy, increased muscle bulk, clitoromegaly, and increased libido; virilization is an ominous sign that suggests the possibility of an ovarian or adrenal neoplasm. Table 50-1 Causes of Hirsutism Gonadal hyperandrogenism Ovarian hyperandrogenism Polycystic ovary syndrome/functional ovarian hyperandrogenism Ovarian steroidogenic blocks Syndromes of extreme insulin resistance Ovarian neoplasms Adrenal hyperandrogenism Premature adrenarche
Functional adrenal hyperandrogenism Congenital adrenal hyperplasia (nonclassic and classic) Abnormal cortisol action/metabolism Adrenal neoplasms Other endocrine disorders Cushing's syndrome Hyperprolactinemia Acromegaly Peripheral androgen overproduction Obesity Idiopathic
Pregnancy-related hyperandrogenism Hyperreactio luteinalis Thecoma of pregnancy Drugs Androgens Oral contraceptives containing androgenic progestins Minoxidil Phenytoin Diazoxide Cyclosporine True hermaphroditism