Endocrine Abstracts

Introduction: Hirsutism is defined as excessive hair growth in androgen-dependent areas in women, related to an increased exposure androgen action in pilosebaceous follicles. It may be isolated, or associated to cutaneous manifestations from acne to signs of virilism. The aim of our study was to describe the therapeutic and evolutionary aspects of hirsutism.

Methods: It was a retrospective study at the endocrinology department of Rabta Hospital in Tunis including 100 women who presented hirsutism with over a period of 10 years from January 2009 to December 2020. Clinical and paraclinical data were collected from medical records.

Results: The average age of our patients was 29.5 ± 10 years old. The mean age at puberty was 12.1 ± 1.2 years old. The onset of hirsutism was acute in 5% of cases. It was associated with spaniomenorhoea, secondary amenorhoea and infertility in 46%, 4% and 10% of cases respectively. Biological hyperandrogenism was present in 59% of cases with a mean testosterone level of 0.9 ± 0.7 ng/ml. Biological and radiological investigations led to the diagnosis of ovarian tumour in 3 patients, adrenal tumour in 5 patients, late-onset congenital adrenal hyperplasia in 7 women, Cushing’s disease in 3 patients and polycystic ovary syndrome in 51 patients. Hirsutism was idiopathic in 32% of cases. Concerning treatment, all patients were recommended to follow hygienic and dietary rules and metformin was associated in eleven cases. Eighteen patients received etiological treatment, i.e. adrenalectomy, oophorectomy, hydrocortisone replacement therapy in 5%, 3% and 7% respectively. While Thirty-four percent were put under estrogen and progestin combination therapy, only 29% were treated with an antiandrogen. An additional treatment by laser hair removal was further done by 11 patients. Evolution was marked by clinical improvement in 46%.

Conclusion: Not only is hirsutism a source of anxiety and social embarrassment for women, but in some cases it can hide a serious illness requiring urgent treatment. That’s why a rigorous etiological investigation is required before the treatment.