Hirsutism natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: ; Ogheneochuko Ajari, MB.BS, MS [2]; Rasam Hajiannasab M.D.[3]

Pubertal onset hirsutism specially when it is mild ,points toward PCOS or idiopathic hirsutism but sever late onset hirsutim with other virlization signs can be due to ovarian or adrenal tumors. Hirsutism can lead to significant psychological distress for women and even depression if left untreated and based on the underlying cause other medical complications can occur (e.g. in cases of hirsutism due to PCOS , if the treatment doesn’t address PCOS , it can lead to infertility.) Prognosis depend on underlying etiology .

The patient’s age of onset of hirsutism can be helpful in the etiologic diagnosis.

• Adrenarche and puberty
  • Early development of pubic hair points toward CAH, because the development of pubic hair depends on adrenal androgens
  • In patients with ovarian hyperandrogenism normal adrenarche and delayed menarche or irregular menses would be expected.^[1]

Hirsutism sometimes can lead to significant psychological distress in patients.^[2] As well as the physical signs of excess hair, hirsutism can affect patients psychologically (mentally). It can cause embarrassment and affect patient’s self-confidence, and therefore the quality of life.Some women feel self-conscious about having unwanted body hair or even may develop depression. Also, although hirsutism doesn’t cause physical complications, the underlying cause of a hormonal imbalance can. For example if hirsutism is due to PCOS , it can lead to infertility.

Prognosis depends on the underlying cause.

Pubertal onset hirsutism, mild hirsutism with slow progression are usually due to benign causes .

In cases of late onset hirsutism (in older women) , rapid and severe hirsutism with other signs of virilization ( including frontal balding, clitoromegaly, increased muscle mass, or deepening of the voice)  , adrenal or ovarian tumors should be considered.^[1]

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