Endocrine Abstracts

Introduction: Hirsutism is defined as excessive pilosity development in women in androgen-dependent areas. It is the main revealing sign of hyperandrogenism. It is a frequent reason for consultation in Endocrinology.

Methods: This is a retrospective study of 82 records of patients hospitalized for exploration of hirsutism in the endocrinology department of Farhat Hached Hospital in Sousse, over a period of 20 years from 1997 to 2017.

Results: The mean age of the patients was 25 years, with extremes of 16 to 38 years. Family history included hirsutism in 41%, diabetes in 29%, hypertension in 22%, and obesity in 13%. Among the patients, 18% were diabetic, with a single case of type 1 diabetes, and 14% were hypertensive. Menstrual disorders such as spaniomenorrhea were observed in 70% of the cases, 23% had secondary amenorrhea. Primary infertility had been found in 6% of cases. Hirsutism appeared in the pubertal period in 40% of cases and in the post-pubertal period in 60% of cases. The major site of hirsutism was the face in 53% of patients. Assessment of hirsutism by the Ferriman-Gallway score showed mild hirsutism in 30% of cases, moderate in 44% of cases and severe presentation in 26% of cases. Overweight had been observed in 42% of the cases, 30% were obese, while 30% of the patients were at normal range. An android distribution of obesity was found in 25% of cases. Acanthosis nigricans was present in 17% of cases, Cushing’s syndrome in 10% and signs of virilization in 3.6%. Biological investigations showed an increase in total testosterone level in 84% of cases. The etiologies found were: polycystic ovary syndrome (PCOS) in 60% of the cases, idiopathic hirsutism in 20% of the cases, Cushing’s syndrome in 11% of the cases (5 cases of Cushing’s disease and 4 cases of cyclic Cushing’s disease), congenital adrenal hyperplasia by 21-hydroxylase deficiency with a late onset in 5% of the cases, and hyperprolactinemia in 4% of the cases.

Conclusion: PCOS is the most common etiology of hirsutism, which develops progressively with a peripubertal onset. However, a careful etiologic investigation is always necessary in order not to miss an ovarian or adrenal virilizing tumor origin in case of recent and rapidly evolving hirsutism.