aetiology
Last reviewed 08/2021
The most common cause are
- polycystic ovarian syndrome (PCOS) – around 72% of women with clinical hyperandrogenism have PCOS (1)
- idiopathic - androgen levels are not increased, resulting from hypersensitivity of the hair follicle to androgen (2). There may be a raised level of peripherally derived androgens such as 3 alpha-androstanediol glucorinide. The condition usually begins in the early teens and increases with age. A family history may be present.
Other causes:
- adrenal -
- non-classic congenital adrenal hyperplasia (less than 5%)
- congenital adrenal hyperplasia
- Cushing's syndrome
- virilizing tumour
- pituitary -
- acromegaly
- hyperprolactinaemia (1)
- ovarian -
- virilising tumours
- gonadal dysgenesis
- thyroid dysfunction (1)
- iatrogenic -
- drugs - androgenic drugs, oral contraceptives, phenytoin
- menopause – is thought to be due to decreasing oestrogen levels leading to unopposed androgen effects, most present with facial hirsutism (4)
- Turner's syndrome
Reference:
- (1) Al Robaee A et al. Update on hirsutism. Acta Dermatovenerol. 2008;17(3):103-19
- (2) Rosenfield R.D. Hirsutism. NEJM 2005; 353:2578-2588
- (3) Hunter MH, Carek PJ. Evaluation and treatment of women with hirsutism. Am Fam Physician. 2003;67(12):2565-72
- (4) Clark C. Advising women with hirsutism. The pharmaceutical journal 2008;280