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hi in this lecture we will review
hirsutism in women hirsutism is defined
as excessive hair growth and woman wear
it should not be this can be a spatial
distribution or a central body
distribution consistent with a male
pattern let's talk about hair follicles
in the embryo when do hair follicles
actually develop
do you know it's okay if you don't
because I'm going to tell you now eight
to ten weeks is usually when we see hair
follicles develop from the epidermal
cells here's another question for you
after how many weeks do we not have new
follicle development in a fetus
well the answer to that is after 22
weeks after 22 weeks no new hair
follicles are made there are three
growing phases of the hair follicle here
is a diagram of the anatomy of the hair
follicle
I doubt you'll have any exam questions
about this but it's just helpful to know
as I discuss hirsutism and women there
are three growing phases antigen the
growth phase catagen the transition
phase intelligent the quiescent phase
let's discuss sexual hair sexual hair
responds to androgens specifically DHT
or dihydrotestosterone the most active
form of testosterone sexual hair
primarily grows on the face normally in
a man abnormally in women which is a
cause for hirsutism sometimes you can
find chest hair and women this is also
abnormal but you do see a male
distribution on a man you can have it on
the lower abdomen and this sometimes is
abnormal and women pubic hair is also
controlled by DHT as well as hair and
the axilla let's now talk about the
development of terminal hair first let's
define vellus hair which is a
pre-pubertal stage then with puberty
onset usually Villas hair is changed to
terminal hair terminal hair tends to be
coarser than Bellis hair estrogens
actually result in the slow growth of
finer and lighter hair and projections
have little to no effect on hair growth
at all viralization
is not to be confused with hirsutism
hirsutism is a less severe
symptomatology is hyper and you nism be
realization is more severe let's review
the different signs and symptoms of v
realization when it may suffer from
temporal balding they may also have
deepening of the voice
they may also have breast atrophy which
is distressing for many women and they
can have overall changes in their body
habitus with more muscular ization
overall women can also experience
clitoral megali when the clitoris
becomes enlarged or lengthened hirsutism
is different again however there is an
excessive male pattern facial and body
hair distribution in women which is
abnormal remember that her 'shit ism
reflects the interaction between
circulating and room levels and the
sensitivity of hair follicles to ambient
stimulation this suggests that actually
different women may be simulated
differently at the level of the hair
follicle this is a high-yield fact is
often quizzed on your exams let's now
review the normal physiology of adrenal
cortex and ovarian and urine production
when it comes to testosterone the
adrenal cortex
Texts makes about 25% Anderson down 50%
DHEA another 50% and DHEA s or sulfated
DHEA 100% you can have peripheral
conversion of DHEA s to DHEA sulphate
ace will cleave the sulfate group you
can also have ovarian production of
anderson diam as well as DHEA and
testosterone recall that as women go
into menopause all of these hormones
will go down now let's talk about
testosterone and men versus women men
usually have a total circulating
testosterone between 200 and 800
nanograms per deciliter in a normal
woman you may see between 20 and 80 mana
grams per deciliter however not all that
testosterone is bioavailable some of it
is actually free and men 3% is free
however overwhelmingly the vast majority
is bound to either albumin or sex
hormone binding globulin in a normal
woman
we see that about 1% is free and the
majority is bound however in a person
woman we find that the percent that is
free is actually doubled however most of
the free testosterone is still bound to
either albumin or SHBG let's not talk
about how you would actually evaluate a
patient who has hirsutism first and
foremost you would like to get a
thorough gynecologic history this
includes the age of menarche and as
you'll recall from other lectures the
average age is 12 then you want to ask
what a description of cycles does she
have all ago men area poly materia all
of these are important then you'd like
to ask about the duration of menses that
means how long does she actually bleed
then you'd like to review other
diagnoses as well as an OB history that
means how many times she's been pregnant
which is the G versus how many times
she's delivered which is a P gravity'
and para is the way we communicate in
ob/gyn we also want to know a family
history that her mother had first isn't
does his sister have first it ISM we
also want to know is the family
generally obese has there been a history
of infertility in her family and what is
her ethnicity as certain ethnicities can
have higher incidences of hirsutism
associated with certain diseases such as
CAH then you'd like to know what the
patient is taking is she taking a
medication that can cause an issue let's
now talk about Andrew and excess in
general this is a study that has
consecutive experience with more than a
thousand patients the differential
diagnosis in these patients were
included in this study if you'd like to
know more information can download this
and to look at it later
I doubt we'll have any examination
questions regarding this table but it
may be helpful to know let's now review
androgen secreting neoplasms this is an
uncommon cause for Andrea and excess and
women but needs to be remembered in the
evaluation ASN accounts for 5% of all
ovarian tumor
most are sertoli latex cell tumors lipid
Sica and cell tumors are also known to
cause hyperandrogenism as well as high
low cell tumors
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you