TAILIEUCHUNG - Chapter 050. Hirsutism and Virilization

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. | Chapter 050. Hirsutism and Virilization 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 HirsutismHair Follicle Growth and DifferentiationHair can be categorized as either vellus fine soft and not pigmented or terminal long coarse and pigmented . The number of hair follicles does not change over an individual s lifetime but the follicle size and type of hair can change in response to numerous factors particularly androgens. Androgens are necessary for terminal hair and sebaceous gland development and mediate differentiation of pilosebaceous units PSUs into either a terminal hair follicle or a sebaceous gland. In the former case androgens transform the vellus hair into a terminal hair in the latter the sebaceous component proliferates and the hair remains are three phases in the cycle of hair growth 1 anagen growth phase 2 catagen involution phase and 3 telogen rest phase . Depending on the body site hormonal regulation may play an important role in the hair growth cycle. For example the eyebrows eyelashes and vellus hairs are androgen-insensitive whereas the axillary and pubic areas are sensitive to low levels of androgens. Hair growth on the face chest .

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