Chapter 050. Hirsutism and Virilization (Part 1) pptx

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