What is Hirsutism ?

Hirsutism is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back. With hirsutism, extra hair growth often arises from excess male hormones (androgens), primarily testosterone.

SYMPTOMS

When high androgen levels cause hirsutism, other signs might develop over time, a process called virilization. Signs of virilization might include :-

CAUSES

Hirsutism may be caused by :->

• Polycystic Ovary Syndrome (PCOS) :- This condition, which often begins with puberty, causes an imbalance of sex hormones. Over years, PCOS may slowly result in excess hair growth, irregular periods, obesity, infertility, and sometimes multiple cysts on the ovaries.
• Cushing Syndrome :- This occurs when your body is exposed to high levels of the hormone cortisol. It can develop from your adrenal glands making too much cortisol or from taking medications such as prednisone over a long period.
• Congenital Adrenal Hyperplasia :- This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
• Tumors :- Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism.
• Medications :- Some medications can cause hirsutism. These include minoxidil, danazol (used to treat women with endometriosis), testosterone, and dehydroepiandrosterone (DHEA). If your partner uses topical products containing androgens, you can be affected as well through skin-to-skin contact.

Normally, the body forms enough new bone tissue to balance the amount of bone tissue broken down and absorbed by the body. This is a natural process called bone turnover. Throughout the early part of your life, the amount of bone lost and the amount gained remains balanced. Bone mass (size and thickness) increases during childhood and early adult life, reaching its maximum by the age of 20 to 25.

Menopause, which usually occurs in a woman’s 40s or 50s, dramatically speeds bone loss. Older men lose bone mass as they age, as well. Osteoporosis develops when your body loses bone faster than it can form new bone. Over time, the imbalance between bone breakdown and formation causes bone mass to decrease, so fractures occur more easily.

Bones in the hip, spine, and wrist are especially prone to fragility fractures—fractures that would not have occurred in a younger person with stronger bones.

Osteopenia, or low bone mass, is a more moderate decline in bone density than occurs in osteoporosis. If you have been diagnosed with osteopenia, or even osteoporosis, you can take steps to prevent further bone loss. You need to exercise and get enough calcium and vitamin D to help keep your bones strong. You also may need to take medications for osteoporosis treatment. Ask your physician what action is right for you. Physicians agree that postmenopausal women and older men with osteoporosis should be medically treated to prevent fractures.

What role do hormones play in bone disease?

Too much or too little of certain hormones in the body can contribute to osteopenia and osteoporosis.

• During and after menopause, the ovaries make much less of the hormone estrogen. Estrogen loss may also occur with surgical removal of the ovaries or because of excessive dieting and exercise. Estrogen helps protect bone.
• Men produce less testosterone (and estrogen—produced in small amounts in males) as they age. Reductions in these hormones may also contribute to bone loss.
• Bone loss can result from the damaging effects of excess cortisol, as occurs in Cushing’s syndrome. Sometimes the adrenal glands produce excess cortisol because of a pituitary gland or other tumor. More commonly, Cushing's syndrome develops as a result of long-term use of corticosteroid medications (steroids) such as prednisone and cortisone, used to treat inflammatory disorders like rheumatoid arthritis or asthma.
• Other hormone imbalances that may increase the risk of osteoporosis include an overactive thyroid gland, diabetes, and hyperprolactinemia, in which the pituitary gland produces too much of the hormone prolactin.
• Thyroid cancer survivors whose treatment includes high doses of thyroid hormone also have a higher risk.
• Eating disorders, especially anorexia nervosa, increase the risk of osteoporosis. Bone loss occurs partly because of poor nutrition and, in women, partly because the ovaries stop functioning normally, producing less estrogen.

Signs and Symptoms

Bone fracture :-

Fractures may trigger serious health problems, including disability and even premature death. Many women and men go through life without knowing they have lost bone mass until they break their hip, spine, or wrist and experience the consequences of this otherwise silent disease.

Some people have spine fractures that lead to a curve in their upper back, sometimes called a dowager's hump. The first suggestion of spinal fractures and one of the first symptoms of osteoporosis may be when you realize you are not as tall as you used to be. Other signs and symptoms are back pain and stooped posture. If you have lost more than one inch from your (accurately measured) height as a young adult, you may wish to speak with your doctor about testing for osteoporosis.

More serious problems may occur after a hip fracture, because some people lose the ability to walk normally, perform activities of daily living, or live independently.

If you are a man or woman at risk for bone loss — and especially if you have experienced a fracture after age 50 — you should have a bone mineral density test to monitor the mass of your bones. Ask your doctor about a dual energy X-ray absorptiometry (DEXA) scan or quantitative low dose CT scan. These safe, simple, and non invasive tests takes only a few minutes and measures the amount of bone present in the spine and hips, which helps diagnose osteoporosis or osteopenia.

It is recommended that all women aged 65 and older, and men aged 70 or older, should have a bone density test. It is also recommended that younger postmenopausal women and men aged 50 to 69 with risk factors for osteoporosis should be tested.

Others who need to be tested include the following :-

• Adults with a condition, such as rheumatoid arthritis, or taking a medication, such as corticosteriods, that may contribute to bone loss
• Anyone whose doctor is considering prescribing osteoporosis drug therapy

Postmenopausal women who are discontinuing estrogen therapy