Hirsutism, affects 58% of the whole female population, results either from an increase in circulating androgen concentrations, an increase in the sensitivity of the pilosebaceous unit to normal androgen concentrations or a combination of these factors. Polycystic ovary syndrome (PCOS) is the underlying cause in vast majority of the patients with hirsutism. PCOS can only be diagnosed after exclusion of some other diseases such as non-classical congenital adrenal hyperplasia (NCAH), idiopathic hyperandrogenemia, Cushings syndrome, hyperprolactinemia and acromegaly. In approximately 18% of the women with hirsutism, NCAH due to 21-hydroxylase deficiency may be diagnosed. Basal or ACTH stimulated 17-OHP concentration greater than 10 ng/ml was considered as the hormonal criteria for 21-OH deficiency. Some hirsute patients do not have evidence of detectable androgen excess or endocrine imbalance, as in women with idiopathic hirsutism. A number of patients have hyperandrogenemia with normal ovarian morphology and regular cycles and called as idiopathic hyperandrogenemia. A correct etiological diagnosis is essential in order to exclude life threatening conditions such as androgen secreting tumors or the life long consequences of some disorders associated with hirsutism such as PCOS and NCAH. Thus certain tests must be conducted to ascertain properly the etiology of hirsutism. However, there is no universal consensus regarding the least required tests for the differential diagnosis of hirsutism. Specific causes of hirsutism such as Cushings syndrome, adrenal/ovarian tumors should be treated by surgical excision of the tumor. In the other patients pharmacological approach is the mainstay of the therapy. The options are anti-androgens, combined oral contraceptive pill with or without anti-androgen agents, gonadotrophin-releasing hormone agonists and rarely insulin sensitizers. Patients should be aware that most of the drugs used in the management of hirsutism are contraindicated in women desiring pregnancy and simultaneous treatment of infertility and hirsutism is difficult.
Declaration of interest: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.