HIRSUTISM IN FEMALES OF REPRODUCTIVE AGE ATTENDING

THE DERMATOLOGY OUT PATIENTS IN A TERTIARY CARE HOSPITAL

ABSTRACT

Background:

Hirsutism is the presence of terminal hairs in a male-like pattern in females, due to elevated male hormone levels. It is a clinical condition commonly seen in primary care practice. The etiology and age of its onset varies widely. Causes of hirsutism range from minor illnesses like fever, nausea, headache to severe conditions like Cushing’s syndrome, neoplasm, congenital adrenal hyperplasia, insulin-resistance syndromes, hyperprolactinemia, polycystic ovarian syndrome, and hyper-thecosis. Factors like drugs, smoking and obesity also contribute to its occurrence while in some cases the cause remains obscure. This study focuses on dietary habits, early menarche, family history, BMI, use of topical contraceptives, oral or parenteral drugs and other related factors which may cause hirsutism. 

Aims:

The study was conducted to see the prevalence of idiopathic hirsutism in females aged 12-20 years, in relation to Polycystic Ovarian Syndrome.

Setting and Duration:

Department of Dermatology, Radiology and Immunology Laboratory at NHRC, Sheikh Zayed Medical Complex, Lahore from Dec 2008 – Dec 2009. 

Patients and Methods:

Clinically confirmed hirsutes and normal females aged between 12-20 years were included in the study while those with virilism, post menopausal, menopause cushing syndrome were excluded. Hirsutes were graded in to 4 grades using Ferriman Gallwey (FG) score Informed consent was obtained from eligible patients. Information was entered in a performa and ultrasound of pelvis was done for polycystic ovarian syndrome and adrenal hyperplasia. Five milliliters of fasting blood was drawn, serum separated and stored at -20ºC, for analysis of LH: FSH ratio, free testosterone, Dihydrotestosterone (DHT), cortisol and Alanine Transferase (ALT). A modified Ferriman-Gallwey (FG) score was used to determine the severity of hirsutism. Who were the controls, how many and did they also undergo all these tests Fifty staff females with no signs of hirsutism were taken as controls. All above mentioned tests were also performed in them.

Results:

A total of 50 patients with hirsutism was seen, whose aged ranged from 18-20 years. Most of these patients had grade 3 and 4 hirsutism with most having 8 years history of hirsutism. Polycystic ovarian syndrome was found in 68% cases and of them 44% had irregular menstrual cycle and were on contraceptive medications. In control group 32% had polycystic ovarian syndrome and all had regular menstrual cycles. Family history of hirsutism was present in 72% cases. No association of hirsutism was found between obesity and polycystic ovarian syndrome. LH:FSH ratio was disturbed in all polycystic ovarian syndrome cases LH: FSH ratio was 2.8:1 in Leuteal phase and 2.5:1 in follicular phase in hirsute females with polycystic syndrome. Whereas it was 0.9:1 in leuteal phase and 0.7:1 in follicular phase in normal females with polycystic ovarian syndrome. Mean levels of free testosterone, Dihydrotestosterone (DHT), cortisol and Alanine Transferase (ALT) were normal in hirsute and normal controls. Dietary items like intake of red meat, chicken, milk and vegetables showed an increase consumption of red meat and broiler chicken was found in hirsute females while in normal females more milk and vegetables were taken in diet.

Conclusions:

About 78% hirsute females had polycystic ovarian syndrome while 12% had idiopathic hirsutism. Familial trend was a common factor for hirsutism. Dietary habits may play a role in causing hirsutism or polycystic ovarian syndrome. 

Key Words: Hirsutism, Polycystic Ovarian Syndrome, Diet, Hormone Levels.