Assessment of hirsutism

Based on the aetiology, hirsutism can be divided into 2 broad categories, with approximately 50% of cases falling under each.[2]Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med. 2005 Dec 15;353(24):2578-88. http://www.ncbi.nlm.nih.gov/pubmed/16354894?tool=bestpractice.com ​​

Increased local sensitivity to androgens or increased local conversion of testosterone to dihydrotestosterone

Idiopathic hirsutism: these women have no identifiable aetiology for the excessive hair growth. They have normal androgen levels and regular menstrual cycles.

Increased androgen levels

• Polycystic ovary syndrome

• Hyperprolactinaemia

• Non-classic congenital adrenal hyperplasia

• Cushing's syndrome (benign or malignant)

• Use of androgenic medication

• Androgen-secreting ovarian tumours

  • Sertoli-Leydig cell tumours (androblastoma, arrhenoblastoma)

  • Granulosa-theca cell tumours

  • Hilus-cell tumours

• Ovarian hyperthecosis (a condition with features similar to polycystic ovary syndrome, but with more severe androgenisation). May occur post-menopausally; the cause is luteinised theca cells, which become hormonally active.