Hirsutism / Virilization

Hirsutism

• Defined as excessive growth of androgen-responsive terminal hair in women
  • excess hair growth in areas where hair growth is normally minimal

Virilization

• Defined as masculinization of a woman
• Presentation
  • clitoromegaly (pathognomonic)
  • acne
  • deepening voice
• ↑ muscle

Associated conditions

• Ovarian (↑ testosterone)
  • polycystic ovarian syndrome
  • ovarian tumors (Sertoli-Leydig cell tumors)
• Adrenal (↑ DHEA-sulfate)
  • congenital adrenal hyperplasia
  • Cushing’s syndrome
  • adrenal tumors
• Drug-related
  • cyclosporine
  • phenytoin
  • minoxidil
• Idiopathic
  • presumed to be caused by increased androgen-receptor sensitivity
• Obesity
  • due to ↓ in steroid-hormone binding globulin (SHBG)
    • results in ↑ concentration of free testosterone
• Hypothyroidism
  • same cause as obesity
• Aromatase deficiency 
  • inability to convert testosterone to estrogen
  • leads to maternal virilization when present in fetus