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Hirsutism and Menstrual Irregularities

Causes of Hirsutism

Functional Ovarian Hyperandrogenism

Polycystic Ovarian Syndrome

Functional Adrenal Hyperandrogenism

Idiopathic

"Non classic" congenital adrenal hyperplasia

Cushing's syndrome

Hyperprolactinemia or Growth hormone excess

Increased peripheral androgen production or sensitivity

Idiopathic hirsutism

Androgen secreting tumors of the ovaries or adrenals

Clinical Approach

Is there evidence of virilization?

Recent onset and/or severe hirsutism with other features of virilization

Exclude tumor hyperandrogenism (ovarian or adrenal)

Usually associated with elevations of androgens more than 2 times normal

Is the patient Cushingoid?

Virilization plus Cushing's syndrome equals adrenal carcinoma until proved otherwise

LH:FSH ratio more than 2 are often but not always seen in PCO (functional ovarian hyperandrogenism)

Prolactin

Thyroid function

Non Classic Congenital Adrenal Hyperplasia;

Usually due to partial deficiency of 21 hydroxylase leading to increased production of 17-OH progesterone

More common in certain ethnic groups

Ashkenazi Jews; Yupic Eskimos

May be asymptomatic or present with functional hyperandrogenism or with infertility

Diagnostic test is ACTH stimulation test, measuring 17-OH progesterone at baseline and 60 min post ACTH

Basal 17-OH progesterone usually >200 ng/dL

Stimulated 17-OH progesterone usually >1000 ng/dL

Hirsutism -