An Evaluation of Hirsutism at Khatam-Alanbia Hospital

Document Type : Research Paper




ntroduction: Hirsutism is a common problem with the presence of terminal (coarse) hair in female, in a male-like pattern, that has different etiologic factors. This project was carried out to determine the etiologic factors of hirsutism with clinical and para clinical studies.
Material and Methods: This descriptive cross sectional study was performed at Khatam –Alanbia Hospital in Zahedan, Iran, from August 2001 to September 2003. Clinical and para clinical findings of 180 hirsute women, referred to Dermatology Clinic were evaluated. Paraclinical tests included serum testostrone, dihydroepandrostendion sulfate, thyroid stimulating hormone, follicle stimulatig hormone, luteinzing hormone, prolactin, 17-OH progesterone, and ultrasonography.
Results: levels of one or more androgens elevated in 70 patients (39%). Poly cystic ovary syndrome was diagnosed in 96 patients (53/3%). A group of 80 patients (44/4%) with regular menstrual cycles and normal laboratory and sonographic findings had idiopathic hirsutism. Of patients 28, (29/2%) with poly cystic ovaries had regular menstruation. Late onset of adrenal hyper plasia, due to partial 21- Hydroxylase deficiency, was diagnosed in 4 patients (2/2%).
Conclusion:There are various causes of excessive hair in women. The present study's results like other studies indicated that poly cystic ovary syndrome is the most common cause and a screening work-up should be recomended on all patients with hirsutism, even women with regular menstrual cycles.


1- Rosenfield RT. Hirsutism. N Engl J Med 2005; 353: 2578-88.
2- Berker D.A. R, Messenger A.G, Sinclair RD. Disorder of hair in: Burns T, Breathnach S,Cox N et al(eds) .Text book of
dermatology Rook .Oxford .Black well Science .2004;(63) 98-107
3- Speroff L, Fritz M A. Hirsutism. In: Speroff L, Fritz M A(eds). Clinical Gynecologic Endocrinology and infertility. 7th
ed.Baltimore. Lippincot.William &Wilkins. 2005: 501-527.
4- Azziz R. The evaluation and management of hirsutism.Obstet Gynecol 2003;101:955-1007.
5-Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev 2000; 21: 347-62.
6-Arndt K A, Leboit PE, Robinson JK et al. Hirsutism and it’s related endocrine disorders. In: Arndt K A, Leboit PE, Robinson
JK et al (eds).Cutaneous Medicine and surgery. Philadelphia. Sunders.1996: 1853-56.
7- James WD, Berger TG, Elston DM. Diseases of skin Appendages. In: James WD, Berger TG, Elston DM (eds). Andrews’
Diseases of the skin .Phildelphia. Sunders 2006; 771-73.
8- Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with unovulation and idiopathic hirsutism .B M J
 9- Carmin E .Prevalence of idiopathic hirsutism .Eur J Endocrinol 1998;139:421-24.
10- Carmin E, Lobo R. Hirsutism, Alopcia and Acne. in: Principles and practice of Endocrinology and Metbolism.Carmin E (ed).
Lippincott.William &Wilkins. 2002: 991-1006.
11- Azziz R, Hincape LA, Knochnahuer ES et al. Screaning for 21-Hidroxylase deficient non classic adrenal hyperplasia among
hyper androgenic women. Fertil Sterill 1999; 72:150-56.
12- Dill-Macky MJ, Atri M. Ovarian Sonography. In: Callen PW (ed).U ltrasonography in obsterics and Gynecology. Sunders.
2000: 857-9.
13- Takhashi K, Eda Y, Abu-musa A, et al. Trasvaginal ultasound imaging ,histopatology and endocrinopathy in patient with
polycystic ovarian syndrome. Hum Reported 1994; 7: 123-36.
14- Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005; 352:1223-36.
15- Hershlay A, Peterson M. Endocrin Disorder. in: Novak’s Gynecology.Berek J S(ed). Lippncot. William &Wilkins. 2002;
16- Khoury MY, Baracat BL, Pardini DP etal. Poly cystic ovary syndrome: Clinical and laboratory evaluation. Rev Paul Med
1996:114; 122-25.
17- Barth JH. Investigation in the assessment and management of patient with hirsutism.Cur Opin Obstet Gynecol 1997; 9: 187-92.
18- Romaquera J, Moran C, Diaz-montes TP, etal. Prevaence of 21-Hydroxylase deficient non clssic adrenal hyperplasia and
insulin resistence among hirsute women from PuertoRico. Fertil Steril 2000;74:59-64.
19- Azziz R, Zacir H. 21 Hydroxylase deficiency in hyperandogenism screaning and diagnosis. J Clin Endocrinol Metah 1989;
69: 577-82.
20- Ehrmann DA, Rosenfield RL, Barnes RB, et al. Detection of functional ovarian hyperandrogenism in women with androgen
excess.N Engl Med. 1992; 327:157-62.
21- Gatee OB, Al Attia HM, Salama IA. Hirsutism in the united Arab Emirates: ahospital study. Post grad Med J.1996; 72: 168 -71.
22- Kutten F, Couillin P, Giard F, et al. Late onset adrenal hyperplasiea in hirsutism. New Engl J Med 1985;313:224-7.
23- Elusterling N E, Telbert L M, Peter H D. Serum testosterone levels in the polycystic ovary syndrome. A M Obestet Gynecol
1974; 76: 1301-4.
24- Greep N, Hoopes M, Horton R. Andrestandiol glucoronide plasma clearance and production rate in normal and hirsute
women. J Clin Endocrinol Metab.1986; 62: 22-25.
25- Carmina E, Lobo RA. Polycysyic ovaries in hirsute women with normal menses. Am J Med. 2001;111: 602-6.
26- Michelmore KF, Balen A H, Punger DB, et al. Polycystic ovaries and assocated clinical and biochemical features in young
women.Clin Endocrinol.1999; 51: 779-86.