Endocrine Abstracts

Hirsutism is the presence of excessive terminal hair in androgen dependent areas of the female body. A frequent medical complaint that affects ∼ 12% of Caucasian premenopausal women, hirsutism usually results from relatively benign functional disorders. Among them, the polycystic ovary syndrome is the most frequent etiology.

The most important tool for the diagnosis of hirsutism is a complete clinical history and physical examination. Functional causes begin peripubertally and progress slowly, whereas the very rare androgen-secreting neoplasms have a sudden onset and a rapid progression of hirsutism, and usually associate clinical signs of virilization and defeminization. The correct diagnostic approach to the hirsute patient requires, in all cases, quantification of hirsutism using the modified Ferriman–Gallwey score, measurement of circulating androgen concentrations, a detailed study of ovulatory function and, possibly, ultrasound assessment of polycystic ovarian morphology. Chronic management must consider not only amelioration of hirsutism but also treatment of the underlying etiology and of any metabolic associations. When caused by a functional disorder, treatment of hirsutism should be chronic and should include cosmetic as well as pharmacological interventions including oral contraceptives and/or antiandrogens. For non-functional disorders treatment should focus on solving the underlying etiology as hirsutism is usually responsive to the elimination of the source of androgen excess.

Declaration of funding

This work was supported by Instituto de Salud Carlos III, Ministerio de Economía y Competitividad (grants PI080944 and PI1100357) and Dirección General de Farmacia, Ministerio de Sanidad, Servicios Sociales e Igualdad (grant EC10-096).