Clinical Features, Diagnosis and Management of Hirsutism

Hirsutism is a common clinical condition encountered in day to day practice. It means excessive growth of terminal hair in women with male characteristics and locations and is usually related to hormonal factors, mainly to increased level of androgens. In female the main sources of androgens, which can produce hirsutism are the adrenal gland (Dehydroepiandrosterone sulfate: DHEA-S) and the ovaries ( 4-androstenedione). Pituitary gland (prolactin) and liver (Sex hormone binding globulin) can also cause hirsutism in few cases. Ectopic hormone production by some tumors may also be responsible for hirsutism, but in few patients all biochemical parameters are absolutely normal. Therefore, it may be sometimes very difficult to understand the pathology of hirsutism in a given case. And one may find difficult to establish the cause of hirsutism and so the treatment, because depending on the origin of the hirsutism, the treatment is based on antiandrogens, oral contraceptive pills, glucocorticoids, GnRH antagonists in association of topical or dermato-cosmetic therapy or lasers. We conducted a literature search and analyzed the causes, types, investigations and management aspects of hirsutism that may help one to understand and manage a case of hirsutism.