Hirsutism may be defined as the excessive growth of terminal hair in the women, with a male pattern of distribution. The clinical presentation is variable, with the presence of other signs of hyperandrogenism like menstrual irregularities and/or infertility, metabolic disturbances associated to hyperinsulinemia/ insulin resistance or presenting only an isolated hirsutism with ovulatory cycles. Hirsutism is an androgen-dependent event and is related to other factors like SHBG and free steroids levels, cutaneous responsivity to androgens and interconversions between androgens and estrogens. It is usually classified in two categories: a) associated to an increase on androgen glandular secretion (ovarian and/or adrenal) or, b) consequent to an exaggerated cutaneous androgen response, namely idiopathic hirsutism. Polycystic ovary syndrome is the more prevalent cause of hirsutism. Non-classical congenital adrenal hyperplasia is more frequent among adrenal diseases inducing hirsutism. Other causes are Cushing syndrome and ovarian and adrenal androgen-producing neoplasias. In the present paper, diagnostic evaluation of hirsutism and the main topics of treatment are critically commented. Indications and limitations of antiandrogens and other related drugs are also described.
Hirsutism; Antiandrogens; Polycystic ovary syndrome; Non-classical congenital adrenal hyperplasia; 5alpha-Reductas
