Classification of hirsutism

Hirsutism refers to the excessive growth of terminal hair, including excessive hair in major parts such as the upper lip, chin, ears, cheeks, lower abdomen, back, chest and proximal limbs. The incidence rate is 5% to 10% in women of childbearing age. The disease may be the initial manifestation of androgen excess.

1.2.1 Physiological hirsutism

Physiological hirsutism, also called idiopathic hirsutism, has an obvious familial tendency. These patients may not be affected by factors such as endocrine and tumors, and the amount of androgens in their serum is normal. However, because the hair follicles are sensitive to low levels of androgens, hirsutism may still occur.

1.2.2 Pathological hirsutism caused by metabolic and endocrine diseases

The most common endocrine disease is polycystic ovarian syndrome (PCOS), accounting for 72% to 82% of hirsutism patients. The key feature of congenital adrenal hyperplasia (CAH) is excessive androgen production. <5% of patients with hirsutism have adrenal cortical hyperplasia. Affected women show hirsutism from peri-puberty onwards, often accompanied by irregular menstruation. Symptoms such as regular or primary amenorrhea. Severe insulin resistance syndrome can stimulate the adrenal glands and ovaries to produce more androgens, while hyperinsulinemia inhibits the liver's synthesis of sex hormone-binding globulin, thereby increasing the concentration of total serum testosterone and causing hirsutism in patients. Hyperprolactinemia, acromegaly, and hypothyroidism are also less common causes of hirsutism.

Androgen-secreting tumors, ovarian theca cell hyperplasia, adrenocorticotroph adenomas, and nonmalignant ovarian diseases are also commonly associated with hirsutism due to excessive androgen secretion.

1.2.3 Secondary effects of drugs

The use of androgen drugs such as testosterone or dehydroepiandrosterone, such as danazol, may be associated with the development of hirsutism. One of the side effects of commonly used immunosuppressants such as cyclosporine is hirsutism. Other drugs include acetazolamide, citalopram, adrenocorticotropic hormone, corticosteroids, metoclopramide, methyldopa, minoxidil, reserpine, streptomycin, sodium valproate, and Heavy metals etc.

1.2.4 Other non-endocrine diseases

Hirsutism can also occur in patients with some systemic diseases, including porphyria, anorexia nervosa, malnutrition, juvenile dermatomyositis, tuberculosis, hypothyroidism, and even paraneoplastic syndromes.