1. Hirsutism Max Brinsmead MB BS PhD July 2012

2. Definition of Hirsutism  Terminal hairs in a female (or child) in a male pattern distribution and amount  Hairs that are not regulated by androgens include: Scalp Eyebrows Eyelashes

3. Role of 5  -Reductase  Converts Testosterone to Dihydrotestosterone in hair follicles  Is increased in both idiopathic and other forms of hirsutism

4. Idiopathic Hirsuitism  Hirsutism with normal menstrual cycles and serum androgens  More common in Mediterranean, Middle Eastern and Southern Asian women  This means that the incidence of hirsutism is culturally determined  Up to 50% of Australian women complain of hirsutism

5. Medical Causes for Hirsutism  PCO Disorder 60 - 80%  Androgen-producing tumour  Congenital Adrenal Hyperplasia  Cushings Syndrome  Drugs

6. The clinical evaluation of hirsutism  When and where is the hair?  Weight and menstrual history  Family history  Drugs  Acne  Symptoms or signs of virilisation  Temporal hair loss  Voice change  Clitoral enlargement

7. Tests for a patient with hirsutism…  Androgens i.e. TEST, SHBG & FAI  HydroxyPROG  DHEAS  PROL & TSH  Ovarian ultrasound

8. Treatment options for hirsutism…  Counselling  Cosmesis  Combined Oral Contraceptive  Cyproterone acetate  With or without COC e.g. Diane  Spironolactone  Causes irregular periods  Topical Eflornithine

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