Hirsutism

Signs of hirsutism may include:

• Coarse, pigmented body hair, primarily on your face, chest and back
• A deepening voice
• Balding
• Acne
• Decreased breast size
• Enlargement of the clitoris
• Increased muscle mass

Causes

Up until puberty, your body is covered with fine, colorless hairs called vellus hairs. When you begin to sexually mature, male sex hormones called androgens help vellus hairs on certain areas of your body become dark, curlier and coarser hairs called terminal hairs. Unwanted terminal hair growth in women (hirsutism) can result from excess androgens or from an increased sensitivity of hair follicles to androgens.

About half the women with mild hirsutism have high androgen levels, and the other half do not. Hirsutism that's severe is usually due to high androgen levels. Conditions that can cause high androgen levels include:

• Polycystic ovary syndrome. This common condition is caused by an imbalance of sex hormones, resulting in irregular periods, obesity, infertility and sometimes, multiple cysts on your ovaries. Polycystic ovary syndrome is the most common identifiable cause of hirsutism.
• Cushing's syndrome. Cushing's syndrome is a condition that occurs when your body is exposed to high levels of the hormone cortisol, a steroid hormone involved in your body's response to stress. It can develop when your adrenal glands — small hormone-secreting glands located just above your kidneys — make too much cortisol, or it can occur from taking cortisol-like medications over a long period. Increased cortisol levels disrupt the balance of sex hormones in your body, which can result in hirsutism.
• Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
• Tumors. Rarely, the cause of hirsutism may be an androgen-secreting tumor in the ovaries or adrenal glands.
• Medications. Some medications can cause hirsutism. One such drug is danazol, which is used to treat women with endometriosis.

Sometimes, no identifiable cause

Excessive hair growth in women with normal androgen levels, regular menstrual periods and no other underlying conditions is called idiopathic hirsutism — meaning that there's no identifiable cause of the disorder. This occurs more frequently in certain ethnic populations.

Risk factors

Several factors may influence your likelihood of developing hirsutism. These include:

• Family history. Several conditions that cause hirsutism, including congenital adrenal hyperplasia and polycystic ovary syndrome, run in families.
• Ethnicity. Women of Mediterranean, Middle Eastern and South Asian ancestry are more likely to develop idiopathic hirsutism than are women of other ethnicities.

Complications

Hirsutism can sometimes be emotionally distressing. Some women may feel self-conscious about unwanted body hair or less "feminine." While hirsutism itself doesn't cause physical complications, the underlying cause of a hormonal imbalance can.

Diagnosis

Making a diagnosis of hirsutism begins with discussing your medical history. Your doctor may ask you about your menstrual cycles, the time of onset of your symptoms, whether you're taking any medications, and a family history of certain conditions. Tests that help make a diagnosis may include:

• Physical exam. Your doctor may check your face, neck, chest, breasts, back, abdomen and pelvis for hair growth. You may also be examined for other signs of androgen excess and for conditions that can result in a hormonal imbalance.
• Blood tests. Tests that measure the amount of certain hormones in your blood, including testosterone, may help determine whether hirsutism is caused by elevated androgen levels.

Further testing

The extent of further testing you'll undergo depends on the severity of your hirsutism and any other associated symptoms. If androgen levels in your blood are elevated, you may undergo imaging tests. These may include:

• Ultrasound. This imaging test uses high-frequency sound waves to produce pictures of your body's internal structures. An ultrasound of the ovaries or adrenal glands may be performed to check for tumors or cysts.
• Computerized tomography (CT) scan. A CT scan is a type of X-ray test that provides cross-sectional images of your internal organs. A CT scan of your body may be used to evaluate the adrenal glands.

References:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856356/

https://en.wikipedia.org/wiki/Hirsutism

http://emedicine.medscape.com/article/121038-treatment

http://www.dermnetnz.org/hair-nails-sweat/hirsutism.html

http://www.irishhealth.com/article.html?con=105