2. Source of androgens in women
•
1-Ovarian theca and stromal cells <LH control
2-Adrenal cortex
3- Peripheral (< pre cursors)
Skin
Adipose tissue
Liver
Placenta
3. Function of androgen in women ?
Estradiol production (aromatisation in
granulosa cells <FSH control)
Sex drive
Muscular mass, etc…
6. The production rate of
testosterone in the
normal female is
0.2 to 0.3 mg/day
Normal total testosterone
concentration in serum
is below 0.8ng/ml
6
13. .
Hirsutism is a consequence of several factors
1.Androgen production
2. The sensitivity of the androgen receptors at
the level of the hair follicle.
3.The activity of 5œ-reductase
14. Role of 5-Reductase
Converts
Testosterone to
Dihydrotestostero
ne in hair follicles
Is increased in
both idiopathic
and other forms
of hirsutism
15. •the commonest cause (90%).
•
•More in African, Mediterranian population.
•Positive family history.
•* No menstrual abnormalities.
* due to increased sensitivity of hair follicle
1) Constitutional (idiopathic):
25. hirsute alone
hirsute with pilosebaceous unit
overactivity (acne)
hirsutism and ovulatory disorders
hirsutism and signs of virilization
Presentation of hirsutism
26. The clinical evaluation of hirsutism
When and where is the hair?
Weight and menstrual history
Family history
Drugs
Acne
Symptoms or signs of virilisation
• Temporal hair loss
• Voice change
• Clitoral enlargement
37. Investigations
Investigations are needed if:
Hirsutism occurs in childhood
There are features of virilization
Hirsutism is of sudden or recent onset
There is menstrual irregularity or cessation
38. Testosterone ng dl)
>200 <200
U/S of the ovary Anovulation
(PRL, TSH)
Adenxal mass Nothing
Laparotomy CT of the adrenala & ovaries
Laparotomy
39. Total Testosterone (T)
DHEA-S (DS)
17-hyroxyprogesterone (17-OHP)
T > 200 ng/dl
DS > 700 μg/dl
Suspect Tumor
17-OHP > 2 ng/ml
Suspect CAH
T Elevated
±
DS Elevated
DS Elevated
T & DS Normal
PCOS
Adrenal
Idiopathic
Laboratory Evaluation
40. PCOS T
LH/FSH
usually inc
2/1
Late-onset CAH 17-OH-P >200 ng/dL
Androgen-secreting ov tumor Total T >200 ng/dL
Androgen-secreting ad tumor DHEAS >700 g/dL
Cushing syndrome Cortisol Increased
Exogenous androgen use Toxicology
screen
Increased
43. OCPs: first option when fertility is not desired
Decrease in LH secretion and decrease in
androgen production
Increase in hepatic production of (SHBG)
Decreased adrenal androgen secretion
44. Cyproterone acetate:
A progestin with strong antiandrogenic action.
Inhibits gonadotrophin secretion and compet
efor androgen receptors on target organs
Dosage-
100mg from D5-D14 with ethinyloestradiol
30µg, from D 5 to D25
45. Androgen receptors blockade
Suppression of Androgen biosynthesis
Increased metabolic clearance of teststerone
( Testosterone Estrogen )
50-200 mg/day pd
Spironolactone + OC is well established regimen
Spironolactone, 50-200 mg per day
47. 47
FLUTAMIDE :
Blocks the androgen receptors
Decreases androgen production
Usually used with Ocs
KETOCONAZOLE:
Equally effective but danger of liver
toxicity
Last resort of treatment.
48. Electrolysis:
.
Needle is inserted into the hair follicle
•a current is used to destroy the dermal papilla.
•All areas, usually the face
•May give permanent removal
•Pain, scarring, painful, repeat treatments needed, time consuming,
expensive, pigmentation
49. b. Laser & intense pulsed light
• A light source sufficient to penetrate to the follicular bulge & the papillae is
directed at the hair by probe.
•All areas
•May give permanent hair reduction, efficient, painless
•Dark hair required, expensive, scarring, skin pigmentation, repeated treatments
usually necessary
50. Treatment options for hirsutism
Counselling
Cosmesis
Combined Oral Contraceptive
Cyproterone acetate
• With or without COC e.g. Diane
Spironolactone
• Causes irregular periods
Topical Eflornithine