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Clinical and biochemical evaluation of patients with hirsutism
Insights
Hirsutism in women can stem from polycystic ovaries or idiopathic causes. Hormone levels often overlap with normal ranges, indicating complex adrenal and ovarian origins for elevated androgens.
Area of Science:
- Endocrinology
- Reproductive Medicine
- Dermatology
Background:
- Hirsutism is a common endocrine concern.
- Distinguishing between polycystic ovary syndrome and idiopathic hirsutism is crucial for management.
- Objective assessment of hair growth and hormonal profiles is essential.
Purpose of the Study:
- To assess clinical and hormonal patterns in patients with moderate to severe hirsutism.
- To investigate the relationship between hirsutism severity and hormone levels.
- To identify the origins of elevated androgens in hirsute patients.
Main Methods:
- Clinical evaluation and hormone measurements in 43 hirsute patients over 18 months.
- Photographic technique for hair growth rate estimation.
- Objective grading scale for hirsutism severity.
- Measurement of serum testosterone, SHBG, free T, androstenedione, DHAS, and gonadotrophins.
Main Results:
- Increased hair growth rates correlated with hirsutism severity.
- 47% of severely affected patients showed virilization.
- Elevated 24-hr urine 17-ketosteroids in severely affected patients.
- Abnormal serum androgen levels (T, SHBG, free T, A, DHAS) were common, with significant overlap.
- Gonadotrophin levels were lower in more severely affected patients.
Conclusions:
- Hormone levels in hirsutism often overlap with normal ranges.
- Elevated androgens can originate from adrenal (DHAS) or combined adrenal/ovarian (T, A) sources.
- Further investigation is needed to elucidate the complex hormonal profiles in hirsutism.
Abstract:
Patients with moderate to severe hirsutism presenting over an 18-month period to an endocrine clinic were assessed by clinical evaluation and hormone measurements. Hair growth rate was estimated by a photographic technique and the severity of hirsutism graded using an objective scale. Of 43 patients, 9 had polycystic ovaries and the remainder were considered to have idiopathic hirsutism. The most severely affected group had significantly increased hair growth rates compared with less clinically affected subjects, and 47% of this group showed objective features of virilization. However, apart from a significantly higher 24-hr urine 17-ketosteroid excretion all other hormonal patterns were not significantly different between severely and mildly affected patients. Serum levels of testosterone (T), sex hormone-binding globulin (SHBG), free T (calculated from T and SHBG values), and androstenedione (A) were abnormal in 44%, 51%, 60% and 60% of patients respectively, whereas plasma levels of the specific adrenal androgen DHAS were increased in 40% of patients. There was an overlap between patients with elevated hormone levels, although isolated elevation of T, A or DHAS were seen in 9%, 19% and 3% of patients respectively. In 19% of patients all serum androgen measurements were normal. Gonadotrophin levels were significantly lower in the more severely affected group. Thus androgen levels in patients with idiopathic hirsutism or polycystic ovaries, show considerable overlap with measurements in normal subjects, and elevated plasma androgens may be of adrenal (DHAS) or combined adrenal/ovarian (T, A) origin.