A Study on Clinical Profile of Patients With Hirsutism

Abstract

BACKGROUND Hirsutism is the presence of terminal hair in male like pattern in females in prepubertal and adult life. It affects 5-10% of women in childbearing age. However, hirsutism has poorly been studied in Indian patients. Aim-To study the clinical profile of patients with hirsutism and to detect its various causes. MATERIALS AND METHODS In this observational cross sectional study, 60 consecutive cases of hirsutism attending the Dermatology and Endocrinology outpatient wings of Govt. Medical College, Kottayam were included. All underwent detailed clinical examination including modified Ferriman-Gallwey scoring and transabdominal ultrasound. Serum total testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone (17-OHP), prolactin, free tri-iodothyronine, free tetra-iodothyronine, and thyroid stimulating hormone, fasting blood glucose and lipid profile were estimated. RESULTS The commonest cause of hirsutism was polycystic ovary syndrome (PCOS) in 42 (70%) cases, followed by idiopathic hirsutism (IH) in 16 (26.7%). There was 1 (1.7%) case each of non-classic congenital adrenal hyperplasia (NCCAH) and acromegaly with pituitary macroadenoma. 53 (88.3%) had mild hirsutism, 5 (8.4%) had moderate and 2 (3.3%) had severe hirsutism. The most common associated sign of hyperandrogenism in our study was seborrhoea (50%), followed by acne (43.3%), acanthosis nigricans (25%) and androgenetic alopecia (18.3%). 5 (8.3%) had associated metabolic syndrome and all of them had PCOS. Limitations-A small sample size and free testosterone levels were not estimated. CONCLUSION PCOS is the most common cause of hirsutism in this study. The term IH should be reserved only for those patients who have negative findings after a thorough investigation. Side burns, which is not included in mF-G scoring were more seen than the involvement of upper arms. The severity of hirsutism shows no correlation with androgen levels. So all hirsute women should undergo a complete workup.