Metabolic Syndrome Hirsutism: Diagnosis and Treatment

Hirsutism, which is a common clinical problem in women of reproductive age, is characterized by excessive growth of terminal hair in the androgen-sensitive skin regions. It is the result of either androgen excess or increased sensitivity of the hair follicles to normal levels of androgens. The therapeutic options of hirsutism can be divided into systemic, topical, and dermato-cosmetic therapies. Patients should be informed that the response to systemic agents is slow; occurring over 3-6 months after therapy has begun. In this review, the diagnosis and treatment of hirsutism were summarized with update literature. Corresponding author: Gokalp Oner, Department of Obstetric and Gynecology, Van Baskale State Hospital, Van, Turkey, E-mail: [email protected] Received February 13, 2012; Accepted February 15, 2012; Published February 18, 2012 Citation: Oner G (2012) Hirsutism: Diagnosis and Treatment. J Metabolic Synd 1:e10 . doi:10.4172/2167-0943.1000e10 Copyright: © 2012 Oner G. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Definition Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women [1]. The causes of hirsutism can be divided into non androgenic factors, hirsutism caused by androgen excess, and idiopathic hirsutism (IH). Non androgenic causes of hirsutism are relatively rare. Non androgenic anabolic drugs cause a generalised growth of many tissues, particularly hair, generally leading to vellus hypertrichosis and not hirsutism [2]. Prevalence The prevalence of hirsutism is approximately 10% in most populations, with the important exception of Far-East Asian women who present hirsutism less frequently [3]. Although usually caused by relatively benign functional conditions, with the polycystic ovary syndrome leading the list of the most frequent etiologies, hirsutism may be the presenting symptom of a life-threatening tumor requiring immediate intervention. Androgenic causes are responsible in up to 80% of patients, and include polycystic ovary syndrome (PCOS), which affects about 70-80% of hirsute women [4,5]; hyperandrogenic insulin-resistant acanthosis nigricans syndrome, affecting about 3% [6]; 21-OH-deficient non classic adrenal hyperplasia in 2-8% of patients; and, very rarely, ovarian or adrenal androgen-secreting neoplasms [7]. As it is known, PCOS is the most frequent cause of hirsutism and IH takes the 2nd place [2]. IH is responsible for approximately 1020% of all hirsutism cases [8]. It is seen more frequently in certain ethnic communities, particularly in women of Mediterranean ancestry. Pathogenesis The pathogenesis of IH is not fully understood. There is little information regarding the pathogenesis of IH in the literature. It has been postulated that 5α-reductase enzyme activity in hair follicles of these patients has increased significantly [9]. Thus, in hair follicles, conversion of testosterone to its more powerful and active metabolite, dihydrotestosterone (DHT) increases. Excessive hair growth may be due to the exaggerated response of hair follicles to normal androgen levels [6]. Also, there might be an alteration in androgen receptor function [10]. Almost all of the testosterone circulating in blood depends on sex hormone binding globulin (SHBG) and albumin. In addition, in most IH patients, increased levels of 3α-androstanediol glucuronid showing 5α-reductase enzyme activity is determined [11]. This suggests that the description of IH is incorrect and in most patients, it is a result of peripheral androgen metabolism dysfunction. Recently, the paradoxically low gene expression levels of local 5α-reductase and aromatase in women with IH were found [12]. Additionally, insulin resistance occurs in nonobese patients with IH and appears to be related to android obesity [13].