Facial Hirsutism Research Articles

Androgens and oligomenorrhea in hirsute women

A recent study demonstrated that hirsute women with irregular menses had higher levels of serum androgens than hirsute women with regular menses. To investigate this finding, we measured total testosterone, biologically active testosterone, free testosterone, androstenedi-one, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in 51 hirsute women with regular menses and compared the levels found to those found in 28 hirsute women with oligomenorrhea. There was no significant difference in the degree of facial hirsutism between the two groups. Oligomenorrheic women had significantly higher levels of free testosterone ( p<0.02) and biologically active testosterone ( p<0.05). The other androgens did not differ significantly between the two groups. The free fractions of testosterone are the metabolically active forms of the hormone and their levels are a function of the rates of production and clearance of testosterone that are elevated in states of hyperandrogenism. This study confirms that hirsute women with oligomenorrhea have higher levels of free and biologically active testosterone than those with regular menses.

Influence of body mass index and age on the grade of hair growth in hirsute women of reproductive ages

The relationships between the hair growth in different body regions, body mass index (BMI) and age were studied in 225 women of reproductive ages referred for hirsutism. The regularity of the cycles was registered, and 109 of the patients were interviewed for their maximum weight, teenage obesity, and age of menarche. The serum androgens were measured in the follicular phase. The results indicate that facial hirsutism is associated with BMI (rho = 0.41, P less than 0.001) independently of age and the testosterone (T) to sex hormone-binding globulin (SHBG) ratio. Facial hirsutism is also correlated with age (rho = 0.37, P less than 0.001) irrespective of BMI (rho = 0.26, P less than 0.001) or the T/SHBG ratio (rho = 0.43, P less than 0.001). In contrast, the hair growth on trunk area is related to the T/SHBG ratio (rho = 0.35, P less than 0.001) but not to BMI or age when the correlations are adjusted for the grade of hyperandrogenemia. The women with severe facial hirsutism had a higher maximum weight (P less than 0.001) and more teenage obesity (P less than 0.01) than other hirsute patients. They also had a slightly earlier menarche compared with their agemates than the women with mild or absent facial hair (P less than 0.05). The data suggest differences in the regulation of hair growth between the face and trunk areas.

Pancreatic Exocrine Aplasia, Clinical Features of Leprechaunism, and Abnormal Gonadotropin Regulation

A female infant displaying morphological and clinical abnormalities is described. She had severe developmental delay, intrauterine growth retardation, and failure to thrive. Her features included an elfin facies, body and facial hirsutism, buttonlike nipples and prominent clitoris and labia. Endocrinological evaluation revealed markedly elevated serum gonadotropin levels. An LHRH stimulation test showed no LH response to LHRH but a rapid and pronounced FSH response. The patient died at 13 months following a respiratory infection. Postmortem examination revealed normal pituitary histology but an unusual pancreatic histology characterized by total absence of acinar cells. This patient had features suggestive of several clinical syndromes including leprechaunism, Shwachman syndrome, and Johanson-Blizzard syndrome, none of which, was completely satisfied. It is concluded that the infant may represent an atypical case of leprechaunism or a previously undescribed syndrome.

172 COMBINATION THERAPY IN AN ADOLESCENT WITH POLYCYSTIC OVARIES, HIRSUTISM, TYPE A INSULIN RESISTANCE, AND ACANTHOSIS NIGRICANS

A 13½ year old female presented with primary amenorrhea, weight gain and hirsutism. Examination revealed a mildly obese adolescent with a deep voice, facial and truncal hirsutism, and acanthosis nigricans in axillae and popliteal fossae. Sexual development was Tanner stage V and clitoral size 8×15 mm. The left ovary was enlarged to palpation.Laboratory evaluation revealed a bone age of 15 years, elevation of serum testosterone and androstenedione and decrease of sex hormone binding globulin (SHBG) (Table). Pelvic ultrasound showed a cystic left ovary; laparoscopy confirmed bilateral polycystic ovaries. A glucose tolerance test showed fasting, peak and 5 hr blood glucoses of 157, 305 and 242 mg/dl, respectively, with insulin levels ranging from 144 uU/ml fasting to > 400uU/ml.The patient was placed on a combination of mestranol 50ug + norethindrone 1 mg daily and spironolactone 25 mg bid. Elevated androgen levels returned to normal and SHBG returned to near normal by 6 months of therapy and remained normal at 2 years. Facial hirsutism improved dramatically in 6 months of therapy and remains under control at 2 years.

Medium-dose oral cyproterone acetate therapy in women with moderate androgenization. Results of a multicenter double-blind study

The low-dose oral standard antiandrogen treatment with cyproterone acetate (CPA), Diane, is frequently associated with unsatisfactory results regarding moderate to severe seborrhoea/acne/acne and/or mild to moderate hirsutism. This multicenter double-blind study (n = 164) was, therefore, initiated to analyze the effectiveness of a medium dose oral regimen, i.e. the addition of 10 mg of CPA during the first 15 days of the Diane-treatment cycle. Good or satisfactory results after 3, 6, 9 and 12 months were observed in 61, 81, 95 and 97% of patients with moderate to severe seborrhoea (n = 79); in 53, 95, 98 and 100% of patients with moderate to severe acne (n = 62); and in 10, 28, 45 and 55% of patients with mild to moderate hirsutism (n = 89), respectively. The regression of moderate facial hirsutism and severe facial acne occurred faster and was more complete under the medium-dose than with the low-dose regimen. Side effects corresponded to those of conventional oral contraceptives except for a higher frequency of mastodynia. Both regimens caused a significant suppression of plasma dehydroepiandrosterone sulfate, while testosterone, triiodothyronine and thyroxine were lowered insignificantly. In contrast, cortisol, prolactin and insulin increased significantly. The extent of these changes did not differ in both modes of treatment. The medium-dose regimen (total dosage per cycle: 192 mg of CPA) is more effective than the low-dose regimen (42 mg of CPA per cycle) in the treatment of patients with moderate hyperandrogenism who do not require the high-dose oral standard antiandrogen therapy (1000 mg of CP A per cycle).

The Partial Adrenocortical Hydroxylase Deficiency Syndrome in Infertile Women

Eighteen infertile women desiring conception were selected for additional diagnostic studies on the basis of clinical evidence of hyperandrogenism characterized by acne and/or facial hirsutism. These 18 patients underwent stimulation tests with adrenocorticotropic hormone which demonstrated the presence of partial adrenocortical hydroxylase deficiences. All patients were then placed on glucocorticoid suppression therapy. Ten patients conceived and, of these, six required no therapy other than prednisone. Four conceived using a combination of prednisone and clomiphene therapy. Of othe eight patients who did not conceive, seven had other significant infertility factors. Therefore, of the patients without other significant fertility factors, 91% conceived. This study demonstrates that partial adrenocortical enzyme defects play a significant role in some women with clinical evidence of hyperandrogenism, and, in such women, either glococorticoid therapy alone or in combination with clomiphene is indicated.

A case of hyperparathyroidism associated with radiation to the head and neck area.

Hyperparathyroidism due to a hyperfunctioning parathyroid adenoma developed in a 57-year-old woman exposed to radiation for facial hirsutism, in whom other tumors of the head and neck had occurred. The details of history and the implications of causal relationship are presented.

The Differential Diagnosis of Hirsutism and Virilism

Robert Lang, MD, Fellow in Endocrinology, the Jewish Hospital of St. Louis, and Instructor in Medicine, Washington University School of Medicine: A 25-year-old white housewife was admitted to Jewish Hospital for evaluation of progressive loss of scalp hair. She had been well all of her life, denying any previous hospitalization or difficulties in obtaining insurance policies. Menarche began at age 12 years, and menstruation, although initially scanty, had been subsequently regular at 25-to 30-day intervals. Progressive development of pubic and axillary hair was associated at the age of 14 years with a gradual loss of scalp hair and increased facial hair. By 20 years of age, baldness was so extensive that the patient began wearing a wig and facial hirsutism could only be effectively controlled by shaving daily. Libidinal desires and body weight remained normal and constant, respectively. She was married at the age of 21 years and had normal

Therapeutic grand rounds number 5. The differential diagnosis of hirsutism and virilism

Robert Lang, MD, Fellow in Endocrinology, the Jewish Hospital of St. Louis, and Instructor in Medicine, Washington University School of Medicine: A 25-year-old white housewife was admitted to Jewish Hospital for evaluation of progressive loss of scalp hair. She had been well all of her life, denying any previous hospitalization or difficulties in obtaining insurance policies. Menarche began at age 12 years, and menstruation, although initially scanty, had been subsequently regular at 25-to 30-day intervals. Progressive development of pubic and axillary hair was associated at the age of 14 years with a gradual loss of scalp hair and increased facial hair. By 20 years of age, baldness was so extensive that the patient began wearing a wig and facial hirsutism could only be effectively controlled by shaving daily. Libidinal desires and body weight remained normal and constant, respectively. She was married at the age of 21 years and had normal

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL. CASE 5-1964.

Presentation of Case First admission. A forty-one-year-old woman entered the hospital because of rectal bleeding and pain.Eleven years previously facial hirsutism developed, necessitating frequent shaving. The patient began to experience occipital headaches that were relieved by vomiting. One year later amenorrhea occurred: she had always had irregular menses and had never been pregnant. At the time of her marriage at seventeen years of age she weighed 129 pounds, but over the next sixteen years her weight gradually increased to 259 pounds. Her mother and sister weighed over 250 pounds; there was no family history of diabetes. Because of . . .

THE TREATMENT OF PSORIASIS AND OTHER DERMATOSES WITH TRIAMCINOLONE (ARISTOCORT)

Sixty patients with psoriasis were treated with triamcinolone, a corticosteroid, in doses of 12 to 16 mg. daily by mouth. In 36 of the patients the response was prompt and unquestionable; within a week, the scaling and erythema diminished significantly, and within two to four weeks of continued adequate dosage the psoriasis was, in some patients, completely erased. Upon cessation of treatment or reduction of dosage, however, the lesions regularly returned. The remaining 24 patients failed to show any response. A wide variety of reversible side-effects were observed. Some were favorable, such as the stimulation of hair-growth in alopecia areata, and many were unfavorable, such as flushing, hyperhidrosis, facial hirsutism, and facial contour changes. Triamcinolone was found to be highly antiallergic, antirheumatic, and antiinflammatory, and therefore useful in a variety of dermatitides; its use in psoriasis should probably be limited to acute extending cases not controllable by other means or to very extensive and severe chronic forms.

ERYTHEMA MULTIFORME FOLLOWING HIGH VOLTAGE ROENTGEN THERAPY

GUIDO HOLZKNECHT 1 reported in 1903, from Low's Sanatorium in Vienna, 5 cases of a generalized febrile illness associated with roentgen dermatitis. The first patient, a 50 year old woman irradiated for facial hirsutism, had fever and an erythema limited to the neck and upper portion of the trunk, in association with a moderately severe roentgen dermatitis of the irradiated areas. Case 2 consisted of a universal papular eruption, with fever, in an 8 year old boy irradiated for psoriasis of the scalp. The third case was that of a 20 year old girl, irradiated for facial hirsutism, who acquired a scarlatiniform eruption with fever. Case 4 occurred in a 5 year old boy with favus of the scalp and consisted of fever and a pruritic, generalized exanthem of small papules, with vesicles in some areas. The fifth case was that of a 50 year old woman with

THE SYNDROME OF INTERNAL FRONTAL HYPEROSTOSIS

There is a syndrome occurring almost exclusively in females, whose pathognomonic sign is internal frontal hyperostosis, and which is generally accompanied by truncal obesity and frequently by facial hirsutism. Certain other metabolic and physiologic disturbances are more or less commonly observed. Considerable experimental, morphologic and pathophysiologic evidence now exists to point to the etiologic importance in this disease of dysfunction of the anterior lobe of the pituitary gland. Neurologic and mental sequelae, as a consequence of the presence of the hyperostoses, appear to be quite infrequent. In the series of cases here presented it was felt that the neuropsychiatric signs and symptoms were not to be attributed to the effect of the hyperostoses on the underlying brain tissue, but were the result of other factors, such as cerebral arteriosclerosis, hypertension, etc. A theory to account for the formation and localization of the hyperostoses has been advanced.