Harrison's Internal Medicine Chapter 50. Hirsutism and Virilization Hirsutism and Virilization: Introduction Hirsutism, defined as excessive male-pattern hair growth, affects approximately 10% of women. It usually represents a variation of normal hair growth, but rarely it is a harbinger of a serious underlying condition. Hirsutism is often idiopathic but may be caused by conditions associated with androgen excess, such as polycystic ovarian syndrome (PCOS) or congenital adrenal hyperplasia (CAH) (Table 50-1). Cutaneous manifestations commonly associated with hirsutism include acne and male-pattern balding (androgenic alopecia). . | Chapter 050. Hirsutism and Virilization Part 1 Harrison s Internal Medicine Chapter 50. Hirsutism and Virilization Hirsutism and Virilization Introduction Hirsutism defined as excessive male-pattern hair growth affects approximately 10 of women. It usually represents a variation of normal hair growth but rarely it is a harbinger of a serious underlying condition. Hirsutism is often idiopathic but may be caused by conditions associated with androgen excess such as polycystic ovarian syndrome PCOS or congenital adrenal hyperplasia CAH Table 50-1 . Cutaneous manifestations commonly associated with hirsutism include acne and male-pattern balding androgenic alopecia . Virilization refers to a condition in which androgen levels are sufficiently high to cause additional signs and symptoms such as deepening of the voice breast atrophy increased muscle bulk clitoromegaly and increased libido virilization is an ominous sign that suggests the possibility of an ovarian or adrenal neoplasm. Table 50-1 Causes of Hirsutism Gonadal hyperandrogenism Ovarian hyperandrogenism Polycystic ovary syndrome functional ovarian hyperandrogenism Ovarian steroidogenic blocks Syndromes of extreme insulin resistance Ovarian neoplasms Adrenal hyperandrogenism Premature adrenarche Functional adrenal hyperandrogenism Congenital adrenal hyperplasia nonclassic and classic Abnormal cortisol action metabolism Adrenal neoplasms Other endocrine disorders Cushing s syndrome Hyperprolactinemia Acromegaly Peripheral androgen overproduction Obesity .
