๐Ÿง”โ€โ™€๏ธ Chapter 72: Hirsutism

๐Ÿ“˜ Nelson's Pediatric Decision-Making Strategies

Polycystic ovary syndrome ยท Idiopathic hirsutism ยท Late-onset CAH ยท Androgen-secreting tumors ยท Hyperthecosis ยท Medications ยท HAIR-AN syndrome

๐Ÿ” Clinical Decision-Making: Hirsutism in Children & Adolescents

๐Ÿ“Š Definitions
โ€ข Hirsutism: excessive terminal hair growth in androgen-dependent areas (face, chest, lower abdomen, thighs) in females
โ€ข Hypertrichosis: diffuse vellus hair growth (non-androgen dependent), often drug-induced or genetic
โ€ข Virilization: signs of masculinization (clitoromegaly, voice deepening, male pattern baldness, increased muscle mass)
๐Ÿฉบ Polycystic Ovary Syndrome (PCOS) โ€“ Most Common
โ€ข Oligomenorrhea/amenorrhea + hyperandrogenism (clinical or biochemical) + polycystic ovaries on ultrasound (exclude other causes)
โ€ข Associated: obesity, insulin resistance, acanthosis nigricans, infertility
โ€ข Lab: elevated free testosterone, DHEAS normal/mildly elevated, LH/FSH ratio >2
โš ๏ธ Red Flags โ€“ Virilization or Rapid Onset
โ€ข Sudden onset or rapid progression suggests androgen-secreting tumor (adrenal or ovarian)
โ€ข DHEAS >700 ฮผg/dL โ†’ adrenal tumor; Testosterone >200 ng/dL โ†’ ovarian tumor
โ€ข Clitoromegaly, deepening voice, increased muscle mass โ†’ severe hyperandrogenism
๐Ÿ“‹ Other Causes
โ€ข Late-onset CAH (21-hydroxylase deficiency): elevated 17-OHP, ACTH stimulation test for diagnosis
โ€ข HAIR-AN syndrome: Hyperandrogenism, Insulin Resistance, Acanthosis Nigricans
โ€ข Medications: phenytoin, minoxidil, cyclosporine, danazol, anabolic steroids
โ€ข Idiopathic hirsutism: normal menses, normal androgens, likely increased 5ฮฑ-reductase activity in hair follicles

๐Ÿ“Œ Decision strategy: PCOS is most common cause in adolescents. Rapid onset or virilization โ†’ tumor. Late-onset CAH if 17-OHP elevated. Idiopathic hirsutism if normal androgens and regular menses.