Pathogenesis (development of disease)
As a rule, hirsutism occurs idiopathically. In southern women, there is mainly familial idiopathic hirsutism. Idiopathic hirsutism is due to increased endoorgan responsiveness to normal serum androgen levels.
Etiology (Causes)
Biographic causes
- Hormonal factors – menopause (female menopause): idiopathic hirsutism.
Behavioral causes
- Overweight (BMI ≥ 25, obesity).
Disease-related causes
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).
- Hermaphroditism verus (hermaphroditism).
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Abnormal cortisol metabolism
- Adrenogenital syndrome (AGS) – autosomal recessive inherited metabolic disorder characterized by disorders of hormone synthesis in the adrenal cortex; these disorders result in deficiency of aldosterone and cortisol; in girls, virilization (masculinization) and pubertas praecox (premature sexual development) in boys, respectively.
- Obesity (overweight)
- Acromegaly – disease caused by overproduction of growth hormone (somatotropic hormone (STH), somatotropin); with marked enlargement of the body limbs.
- Cushing’s disease/Cushing’s syndrome – disease in which a tumor in the ACTH-producing cells of the pituitary gland produces too much ACTH, resulting in increased stimulation of the adrenal cortex and, as a consequence, excessive cortisol production.
- Hyperprolactinemia – increase in the level of prolactin in the blood.
- Ovarian hyperandrogenemia – too much androgen production in the ovaries.
- Polycystic ovary syndrome (PCO syndrome) – symptom complex characterized by hormonal dysfunction of the ovaries [50% of all women with hirsutism].
- Syndromes of extreme insulin resistance (decreased effectiveness of endogenous insulin at target organs skeletal muscle, adipose tissue and liver).
- Premature andrenarche – premature onset of adrenal maturation, characterized in girls by an increase in adrenal 17-ketosteroid production (usually: from about age nine). At this time, the prohormone dehydroepiandrosterone (DHEA) and its sulfated form (DHEAS) increases measurably.
Neoplasms – tumor diseases (C00-D48).
- Adrenal neoplasms, unspecified – neoplasms arising from the adrenal gland.
- Ovarian neoplasms, unspecified – neoplasms originating from the ovaries (ovary)
- Thecom – rare, usually (benign) benign tumor arising from the theca cells of the ovaries.
Pregnancy, childbirth and puerperium (O00-O99).
- Pregnancy-associated hyperandrogenemia (overproduction of male sex hormones) as seen in corpus luteum hyperreactivity.
Medications
- Anabolic steroids – substances that promote the buildup of the body’s own tissues primarily through increased protein biosynthesis (new protein formation).
- Androgens – male sex hormones.
- Anticonceptives (“pill”) with androgenic partial effect.
- Ciclosporin (cyclosporin A) – drug from the group of immunosuppressants.
- Danazol – antigonadotropin leading to eversible inhibition of synthesis and/or secretion of the pituitary gonadotropins LH (luteinizing hormone) and FSH (follicle-stimulating hormone); danazol is used to treat endometriosis (improvement of symptoms such as: Dysmenorrhea (period pain), abdominal pain and dyspareunia, i.e. pain during intercourse).
- Diazoxide – drug used as an antihypertensive (high blood pressure medication).
- Minoxidil – drug which is used for hypertension and alopecia.
- Phenytoin – drug from the group of antiepileptic drugs.
- Progestins – are synthetic substances similar to progesterone (C21- steroids).
- Spironolactone (potassium-sparing diuretic) – drug from the group of diuretics (used to flush out water).
