Virilization and Hirsutism – Gynecology | Lecturio


[Music] hi in this lecture we will review hirsutism in women hirsutism is defined as excessive hair growth and woman wear it should not be this can be a facial distribution or a central body distribution consistent with a male pattern let’s talk about hair follicles in the embryo when do hair follicles actually develop do you know it’s okay if you don’t because I’m going to tell you now eight to ten weeks is usually when we see hair follicles develop from the epidermal cells here’s another question for you after how many weeks do we not have new follicle development in a in a fetus well the answer to that is after 22 weeks after 22 weeks no new hair follicles are made there are three growing phases of the hair follicle here is a diagram of the anatomy of the hair follicle I doubt you’ll have any exam questions about this but it’s just helpful to know as I discuss hirsutism and women there are three growing phases antigen the growth phase catagen the transition phase intelligent the quiescent phase let’s discuss sexual hair sexual hair responds to androgens specifically DHT or dihydrotestosterone the most active form of testosterone sexual hair primarily grows on the face normally in a man abnormally in women which is a cause for hirsutism sometimes you can find chest hair and women this is also abnormal but you do see a male distribution on a man you can have it on the lower abdomen and this sometimes is abnormal and women pubic hair is also controlled by DHT as well as hair and the axilla let’s now talk about the development of terminal hair first let’s define vellus hair which is the pre-pubertal stage then with puberty onset usually villus hair is changed to terminal hair terminal hair tends to be coarser than Bellis hair estrogens actually result in the slow growth of finer and lighter hair and progestins have little to no effect on hair growth at all viralization is not to be confused with hirsutism hirsutism is a less severe symptomatology of hyperandrogenism be realization is more severe let’s review the different signs and symptoms of v realization when it may suffer from temporal balding they may also have deepening of the voice they may also have breast atrophy which is distressing for many women and they can have overall changes in their body habitus with more muscular ization overall women can also experience clitoral megali when the clitoris becomes enlarged or lengthened hirsutism is different again however there is an excessive male pattern facial and body hair distribution in women which is abnormal remember that hirsutism reflects the interaction between circulating and room levels and the sensitivity of hair follicles to Andrew and stimulation this suggests that actually different women may be stimulated differently at the level of the hair follicle this is a high-yield fact it’s often quizzed on your exams let’s now review the normal physiology of adrenal cortex and ovarian and reproduction when it comes to testosterone the adrenal cortex Texts makes about 25% Anderson down 50% DHEA another 50% and DHEA s are sulfated DHEA a hundred percent you can have peripheral conversion of DHEA s to DHEA sulphate ace will cleave the sulfate group you can also have ovarian production of Anderson down as well as DHEA and testosterone recall that as women go into menopause all of these hormones will go down now let’s talk about testosterone and men versus women men usually have a total circulating testosterone between 200 and 800 nanograms per deciliter in a normal woman you may see between 20 and 80 nanograms per deciliter however not all that testosterone is bioavailable some of it is actually free and men 3% is free however overwhelmingly the vast majority is bound to either albumin or sex hormone binding globulin in a normal woman we see that about 1% is free and the majority is bound however in a hurry woman we find that the percent that is free is actually doubled however most of the free testosterone is still bound to either albumin or SHBG let’s now talk about how you would actually evaluate a patient who has hirsutism first and foremost you would like to get a thorough gynecologic history this includes the age of menarche and as you’ll recall from other lectures the average age is 12 then you want to ask about a description of cycles does she have a legume in area Holyman area all of these are important then you’d like to ask about the duration of menses that means how long does she actually bleed then you’d like to review other diagnoses as well as an OB history that means how many times she’s been pregnant which is a G versus how many times she’s delivered which is a P gravity’ and para is the way we communicate in ob/gyn we also want to know a family history does her mother have hirsutism does her sister have hirsutism we also want to know is the family generally obese has there been a history of infertility in her family and what is her ethnicity as certain ethnicities can have higher incidences of hirsutism associated with certain diseases such as CAH then you’d like to know what the patient is taking is she taking a medication that can cause an issue let’s now talk about Andrew and excess in general this is a study that has consecutive experience with more than a thousand patients the differential diagnosis in these patients were included in this study if you’d like to know more information you can download this and to look at it later I doubt you’ll have any examination questions regarding this table but it may be helpful to know let’s now review androgen secreting neoplasms this is an uncommon cause for Android and access and women but needs to be remembered in the evaluation ASN accounts for 5% of all ovarian tumors most are sertoli late Excel tumors lipid theca and cell tumors are also known to cause hyperandrogenism as well as Hylas cell tumors [Music]

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