Hirsutism - Causes and Symptoms

Definition

In women, hirsutism consists in the excessive development of thick and dark hair, in areas of the body where they normally should not be present. The distribution of these terminal hairs, in particular, is typically male; they are located on the face, chest, lower abdomen, inner thigh and back.

Men can also be more or less hairy, but this symptom rarely arouses their concern.

The growth of skins depends on the balance between androgens, which promote the growth of thick and dark hairs, and estrogens, which modulate the development of thinner and lighter hairs. When hirsutism is caused by an increase in androgens, it is often accompanied by virilization, with the disappearance of menstruation, acne, increased muscle mass, overweight and a deep voice. This can occur due to ovarian disorders (eg, polycystic ovary syndrome and hypertecosis), adrenal diseases (eg congenital adrenal hyperplasia) or pituitary diseases (eg Cushing's disease, acromegaly and prolactin-secreting pituitary adenoma). Abrupt onset hirsutism may indicate ectopic secretion of hormones by carcinoid, ovarian, adrenal and pulmonary tumors.

Hirsutism not associated with an excess of androgens, on the other hand, can be physiological, as happens after menopause or during pregnancy. In other cases, it is the result of systemic endocrine conditions that indirectly cause an androgen imbalance, such as in hyperinsulinemia and hypothyroidism.

Another cause is family hirsutism, widespread especially in Mediterranean or Middle Eastern populations and secondary to an amplified receptor response to normal plasma androgen levels.

Hirsutism can also occur in isolation. In other cases, it is a consequence of the intake of anabolic steroids, danazol and oral contraceptives.