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Idiopathic hirsutism: an uncommon cause of hirsutism in Alabama
R Azziz1, W T Waggoner, T Ochoa
1Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 35233-7333, USA. razziz@uabmc.edu
Objective:
To determine the prevalence of idiopathic hirsutism among a population of consecutive hirsute patients.
Design:
Prospective cohort study.
Setting:
University-based clinic.
Patient(S):
Premenopausal women with a complaint of hirsutism who were not receiving hormonal therapy.
Intervention(S):
Evaluations for total and free testosterone, (T), 17-hydroxyprogesterone (17-HP), and DHEAS serum levels.
Main Outcome Measure(S):
Ovulatory function in women with cycles of < or =35 days in length was assessed with a basal body temperature (BBT) calendar and day 22-24 progesterone levels.
Result(S):
Of 132 consecutive hirsute women studied, 68 had cycles of >35 days in length. Of the remaining 64 patients, 25 also had oligo/anovulation by BBT and day 22-24 progesterone level. Of the 39 patients with hirsutism and regular ovulatory function, 22 had total and free T and DHEAS levels within normal limits.
Conclusion(S):
If idiopathic hirsutism is defined by the presence of hirsutism, regular ovulation, and normal androgen levels, only 17% of consecutive hirsute patients can be diagnosed with the disorder. Alternatively, if idiopathic hirsutism is based solely on the presence of hirsutism and regular ovulation, regardless of androgen levels, then 29% of the total hirsute population can be considered as having idiopathic hirsutism. Importantly, 40% of hirsute patients with a history of "regular cycles" were actually oligo/anovulatory, indicating the need to objectively assess ovulatory function in such patients.