Is Idiopathic Hirsutism Truly Idiopathic?

Area of Science:

• Endocrinology
• Reproductive Medicine
• Metabolic Health

Background:

• Idiopathic hirsutism (IH) and patient-important hirsutism (PIH) are characterized by excess hair growth in women.
• Classical definitions often exclude elevated levels of androgens like androstenedione (A4), 17-hydroxyprogesterone (17OHP), and dehydroepiandrosterone (DHEA).
• The role of less common androgens in hirsutism requires further investigation.

Purpose of the Study:

• To investigate the prevalence of elevated A4, 17OHP, and DHEA in women diagnosed with classically defined IH/PIH.
• To assess whether these androgens are elevated despite normal testosterone levels and regular menstrual cycles.

Main Methods:

• Retrospective analysis of 30 women with IH/PIH from an outpatient endocrine department.
• IH/PIH defined by hirsutism, normal menstrual cycles, normal total and free testosterone, and normal ovarian ultrasound.
• Androgen levels (A4, 17OHP, DHEA, DHEAS) measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Main Results:

• Elevated dehydroepiandrosterone (DHEA) was found in 60% of patients, and elevated androstenedione (A4) in 33%.
• Overall, 73% of women exhibited elevated levels of at least one androgen (DHEA and/or A4) while maintaining normal testosterone levels.
• No significant correlation was observed between androgen levels and the modified Ferriman-Gallwey score, nor were there significant differences between IH and PIH groups.

Conclusions:

• A substantial proportion of women with classically defined IH/PIH present with elevated DHEA and/or A4.
• While these findings may not alter current pharmacotherapy, they highlight the importance of sensitive androgen assays.
• Further studies are warranted to explore the impact of this detected hyperandrogenemia on metabolic functions and cardiovascular risk.