Polycystic ovary syndrome (PCOS) is the most common cause of excessive androgen production.

Congenital adrenal tumors and other androgen-producing tumors are rare and often present with different symptoms when they occur.

Cushing’s syndrome, hyperprolactinemia, acromegaly, thyroid disorders

Cushing’s syndrome is associated with both hypertrichosis and hirsutism.

Use of androgenic and anabolic steroids;Excessive hair growth – symptoms and diagnosis of hirsutism

Most women with increased hair growth sometimes do not have an increase in hormones, this is called idiopathic hirsutism or they have polycystic ovary syndrome. Excessive prolactin hormone, overworking of the adrenal (adrenal) gland and some drugs used can also cause hair growth. Sometimes, tumors in the ovaries and adrenal glands can also cause excessive hair growth.

In patients with tumors, hair growth begins suddenly and rapidly. Hair falls out, the voice thickens and a male-type structure is formed. For diagnosis, ovarian and adrenal gland tomography is performed. Testosterone, androstenedione, 17 alpha hydroxy progesterone and prolactin hormones should be checked in the diagnosis of hirsutism. If women with hair growth have high blood testosterone, 65-85% of them have polycystic ovaries.

If the adrenal glands are enlarged, the 17 hydroxy progesterone (OHP) level will be high. 17-OHP concentration >30 nmol/L after ACTH injection (Synacten) is accepted as a diagnostic criterion for 21-hydroxylase enzyme deficiency. The cause of idiopathic hirsutism is unknown. There is an increased sensitivity to testosterone in the blood in the hair follicles. Women with polycystic ovary syndrome may experience hair loss, acne, and menstrual irregularities in addition to hair growth. These women are at risk for weight gain and diabetes.

Investigations required for excessive hair growth

Development of hirsutism: age, weight gain, discontinuation of oral contraceptives

Sudden onset and progression indicates a tumor, but slow progression does not eliminate the possibility of a tumor.

Localization of hirsutism and differentiation from hypertrichosis

Female hyperandrogenism should be suspected if hair growth has occurred in the following areas:

face: mustache, beard, cheeks

chest wall: scapular area and between the breasts

abdomen: from the navel above the midline or between the pubic hair and the navel

arms and legs: hair on the inside of the thighs is abnormal.

Hypertrichosis refers to a general condition of excessive body hair growth.

Hypertrichosis is not linked to androgens.

genetic and ethnic factors

Onset after puberty, exacerbated by discontinuation of oral contraceptives and weight gain

Glucocorticoids, phenytoin, cyclosporine and minoxidil may cause hypertrichosis.