Hirsutism in adolescent: A review

Abstract

Hirsutism is an embarrassing condition of females characterized by excessive and unwarranted growth of terminal hair on the face and other androgen-dependent areas of sexual hair growth (male pattern). It is a common clinical problem for females and a sign of increased androgenic activities. Polycystic ovarian syndrome (PCOS) is the most common (70-80%) cause followed by idiopathic hirsutism. Other causes are congenital adrenal hyperplasia, androgen-secreting tumours, Cushing’s syndrome, acromegaly, hypothyroidism, (rarely), hyperprolactinemia and medications. Hirsutism should be differentiated from hypertrichosis where excessive hair grows on non-selective and nonsexual areas of females without androgenic influence. Hirsutism imposes an extra psychological burden on adolescents when they are adapting to physical, endocrine and environmental changes. A hirsute adolescent girl may lose significant self-esteem and suffers from serious psychological comorbidities. Diagnosis and management of underlying causes of hirsutism especially PCOS in adolescent girls are controversial and challenging. Disease severity can be measured by using modified Ferriman–Gallwey scoring system. Clinical and laboratory evaluation for hyperandrogenism including testosterone is mandatory for females with significant hirsutism scores. A serum testosterone level > 200 ng/dL strongly indicates an adrenal or ovarian tumour and further evaluation is essential. For the management of hirsutism, a multimodal approach is necessary where hair removal and management of underlying causes should be continued at the same time.

Keywords: Hirsutism, PCOS, Adolescent.