Podcast
Questions and Answers
What is the primary defining characteristic of hirsutism?
What is the primary defining characteristic of hirsutism?
- Localized hair growth in women
- Excessive terminal hair growth in women in a male pattern (correct)
- Reduced hair growth in androgen-dependent areas
- Excessive body hair growth in men
Which scoring method is considered the gold standard for evaluating hirsutism?
Which scoring method is considered the gold standard for evaluating hirsutism?
- Modified Ferriman–Gallwey score (correct)
- Bristow score
- Bartholin score
- Hormonal evaluation score
In the Ferriman–Gallwey score, what does a score of 0 indicate?
In the Ferriman–Gallwey score, what does a score of 0 indicate?
- Mild hirsutism
- No hair growth in that area (correct)
- Normal hair growth
- Severe hirsutism
What percentage of the population is used as a threshold for diagnosing hirsutism?
What percentage of the population is used as a threshold for diagnosing hirsutism?
For the treatment of hirsutism, which type of oral contraceptive (OC) is mentioned as equally effective?
For the treatment of hirsutism, which type of oral contraceptive (OC) is mentioned as equally effective?
How is excessive terminal hair classified when it appears in areas sensitive to androgens?
How is excessive terminal hair classified when it appears in areas sensitive to androgens?
Which of the following is not a characteristic of hirsutism?
Which of the following is not a characteristic of hirsutism?
Which statement is true about antiandrogens compared to other oral contraceptives?
Which statement is true about antiandrogens compared to other oral contraceptives?
What is the effect of antiandrogenic progestins on hirsutism scores compared to other oral contraceptives?
What is the effect of antiandrogenic progestins on hirsutism scores compared to other oral contraceptives?
How do androgenic progestins affect testosterone production?
How do androgenic progestins affect testosterone production?
What were the results of the trials pooling antiandrogens together in terms of effectiveness compared to placebo?
What were the results of the trials pooling antiandrogens together in terms of effectiveness compared to placebo?
What is a possible clinical implication of the difference in hirsutism scores among various progestins?
What is a possible clinical implication of the difference in hirsutism scores among various progestins?
What role does sex hormone-binding globulin (SHBG) play regarding androgens in serum?
What role does sex hormone-binding globulin (SHBG) play regarding androgens in serum?
What is one of the doses of spironolactone used to manage hirsutism?
What is one of the doses of spironolactone used to manage hirsutism?
Which progestin is noted to have a relatively androgenic effect among oral contraceptives?
Which progestin is noted to have a relatively androgenic effect among oral contraceptives?
What is a significant concern associated with flutamide use?
What is a significant concern associated with flutamide use?
What is a proposed mechanism for how antiandrogenic progestins affect hirsutism?
What is a proposed mechanism for how antiandrogenic progestins affect hirsutism?
Which dose of flutamide is most frequently used in randomized controlled trials?
Which dose of flutamide is most frequently used in randomized controlled trials?
In the treatment of hirsutism, what is a common recommendation regarding glucocorticoid therapy for women with classic congenital adrenal hyperplasia?
In the treatment of hirsutism, what is a common recommendation regarding glucocorticoid therapy for women with classic congenital adrenal hyperplasia?
Which of the following statements about low-dose flutamide and hirsutism is accurate?
Which of the following statements about low-dose flutamide and hirsutism is accurate?
What role do glucocorticoids have in the management of women with nonclassic 21-hydroxylase deficiency?
What role do glucocorticoids have in the management of women with nonclassic 21-hydroxylase deficiency?
What is the primary reason for using flutamide in combination therapies?
What is the primary reason for using flutamide in combination therapies?
What percentage of women studied experienced elevated serum alanine aminotransferase and/or aspartate aminotransferase while taking low doses of flutamide?
What percentage of women studied experienced elevated serum alanine aminotransferase and/or aspartate aminotransferase while taking low doses of flutamide?
What is a noted outcome of suppressing adrenal androgens in highly sensitive patients using glucocorticoids?
What is a noted outcome of suppressing adrenal androgens in highly sensitive patients using glucocorticoids?
What is suggested against as initial therapy for most women with hirsutism?
What is suggested against as initial therapy for most women with hirsutism?
What is the primary reason for not recommending antiandrogen monotherapy as initial therapy?
What is the primary reason for not recommending antiandrogen monotherapy as initial therapy?
What should be considered when prescribing antiandrogen medication for women with hirsutism?
What should be considered when prescribing antiandrogen medication for women with hirsutism?
In the context of hirsutism, what condition may be evaluated through checking androgen levels?
In the context of hirsutism, what condition may be evaluated through checking androgen levels?
What does the abbreviation 'NCCAH' stand for in the context of adrenal conditions?
What does the abbreviation 'NCCAH' stand for in the context of adrenal conditions?
What is the purpose of testing androgen levels in women presenting with hirsutism?
What is the purpose of testing androgen levels in women presenting with hirsutism?
Which hormone is not typically related to hirsutism?
Which hormone is not typically related to hirsutism?
What does the acronym 'RCT' stand for in clinical studies related to hirsutism?
What does the acronym 'RCT' stand for in clinical studies related to hirsutism?
What is the expected prevalence of NCCAH among hyperandrogenic women?
What is the expected prevalence of NCCAH among hyperandrogenic women?
What percentage of hirsute women are classified as having idiopathic hirsutism?
What percentage of hirsute women are classified as having idiopathic hirsutism?
Which disorder must clinicians consider in the differential diagnosis when evaluating hirsutism?
Which disorder must clinicians consider in the differential diagnosis when evaluating hirsutism?
What might exacerbate the features of PCOS in women?
What might exacerbate the features of PCOS in women?
What condition is characterized by androgen-secreting tumors, which are malignant in over half of the cases?
What condition is characterized by androgen-secreting tumors, which are malignant in over half of the cases?
Which of the following hormonal conditions is least likely to be involved in the assessment of hirsutism?
Which of the following hormonal conditions is least likely to be involved in the assessment of hirsutism?
What is the common hormonal change associated with hirsutism in women with no other clinical evidence of PCOS?
What is the common hormonal change associated with hirsutism in women with no other clinical evidence of PCOS?
What percentage of eumenorrheic women with mild hirsutism may have idiopathic hirsutism?
What percentage of eumenorrheic women with mild hirsutism may have idiopathic hirsutism?
What is the relationship between estrogen dose and VTE risk?
What is the relationship between estrogen dose and VTE risk?
Which combined oral contraceptive does NOT refer to the content discussed?
Which combined oral contraceptive does NOT refer to the content discussed?
What is a potential increased risk factor for VTE when using certain OCs?
What is a potential increased risk factor for VTE when using certain OCs?
Which type of progestins are linked to a higher VTE risk according to the text?
Which type of progestins are linked to a higher VTE risk according to the text?
What does the evidence suggest about the risk posed by DSP in relation to VTE?
What does the evidence suggest about the risk posed by DSP in relation to VTE?
Which progestins are considered to have low androgenicity?
Which progestins are considered to have low androgenicity?
What conclusion did the Pharmacovigilance Risk Assessment Committee reach regarding CPA?
What conclusion did the Pharmacovigilance Risk Assessment Committee reach regarding CPA?
How does the absolute risk of VTE with combined OCs compare to that during pregnancy?
How does the absolute risk of VTE with combined OCs compare to that during pregnancy?
Flashcards
Hirsutism diagnosis
Hirsutism diagnosis
Testing for elevated androgen levels in women with abnormal hirsutism scores is recommended.
Hirsutism treatment
Hirsutism treatment
Antiandrogen monotherapy is generally not recommended as initial therapy for hirsutism due to potential teratogenic effects, unless adequate contraception is employed.
Hirsutism
Hirsutism
Excessive terminal hair growth in women that follows a male pattern.
Ferriman-Gallwey score
Ferriman-Gallwey score
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Local hair growth
Local hair growth
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VTE Risk and Estrogen
VTE Risk and Estrogen
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OCs and Progestins
OCs and Progestins
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Low-Androgenicity Progestins
Low-Androgenicity Progestins
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Androgen Receptor Antagonists
Androgen Receptor Antagonists
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Comparison of Progestins(Levonorgestrel)
Comparison of Progestins(Levonorgestrel)
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PCOS and VTE
PCOS and VTE
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Absolute Risk of VTE
Absolute Risk of VTE
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OCs containing antiandrogenic progestins
OCs containing antiandrogenic progestins
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Combined oral contraceptives (COCs)
Combined oral contraceptives (COCs)
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Ferriman-Gallwey score
Ferriman-Gallwey score
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Androgenic progestins
Androgenic progestins
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Spironolactone
Spironolactone
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Hirsutism
Hirsutism
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Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS)
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Androgen elevation
Androgen elevation
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Idiopathic hirsutism
Idiopathic hirsutism
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Metabolic syndrome
Metabolic syndrome
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Eumenorrheic women
Eumenorrheic women
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Androgen-secreting tumour
Androgen-secreting tumour
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Cushing syndrome
Cushing syndrome
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Acromegaly
Acromegaly
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Hypothyroidism
Hypothyroidism
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Hyperprolactinemia
Hyperprolactinemia
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Exogenous androgens
Exogenous androgens
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Antiandrogen (CPA)
Antiandrogen (CPA)
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Hirsutism score
Hirsutism score
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Flutamide
Flutamide
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Hepatic toxicity
Hepatic toxicity
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Glucocorticoids
Glucocorticoids
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Adrenal hyperandrogenism
Adrenal hyperandrogenism
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Combination therapy (low-dose flutamide)
Combination therapy (low-dose flutamide)
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21-hydroxylase deficiency
21-hydroxylase deficiency
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Nonclassic 21-hydroxylase deficiency
Nonclassic 21-hydroxylase deficiency
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RCTs (Randomized Controlled Trials)
RCTs (Randomized Controlled Trials)
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Clinical data
Clinical data
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Study Notes
Evaluation and Treatment of Hirsutism in Premenopausal Women
- Objective: Update a 2008 Endocrine Society clinical practice guideline.
- Participants: Endocrine Society-appointed task force of seven medical experts and a methodologist.
- Evidence: Developed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Used systematic reviews and best available evidence from other publications.
- Consensus Process: Group meetings, conference calls, and email communications. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on the drafts.
- Conclusion: Suggest testing for elevated androgen levels in all women with abnormal hirsutism scores. Do not test eumenorrheic women with unwanted local hair growth (without abnormal hirsutism scores).
- Treatment for Hirsutism: For women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), suggest starting with pharmacological therapy and adding direct hair removal (electrolysis, photoepilation) if needed. Mild hirsutism with no endocrine disorder can use either approach (pharmacological therapy or direct hair removal).
Diagnosis of Hirsutism
- Testing Recommendations: Suggest testing for elevated androgens in all women with an abnormal hirsutism score. If serum total testosterone levels are normal, and hair growth is moderate/severe or mild with hyperandrogenic clinical signs, measure early morning total and free testosterone.
- NCCAH Screening: Suggest screening for NCCAH (21-hydroxylase deficiency) in women with hirsutism, particularly if they have a family history, or belong to a high-risk ethnic group, regardless of normal testosterone levels. Measure early morning 17-hydroxyprogesterone levels during the follicular phase for amenorrheic women, or any random day.
- Normal Local Hair Growth: Do not test eumenorrheic women with unwanted local hair growth (no abnormal hirsutism score).
Treatment of Hirsutism in Premenopausal Women
- Pharmacological Therapies: Oral combined estrogen-progestin contraceptives are the initial treatment for patient-important hirsutism in women not seeking fertility.
- Antiandrogen Monotherapy: Suggest against antiandrogen monotherapy as initial therapy, except for women not sexually active, permanently sterilized, or using long-acting reversible contraception. Their choice is dependent on personal preferences.
- Oral Contraceptives: Do not suggest one oral contraceptive over another as initial therapy given similar efficacy and low side effects.
- VTE Risk: Suggest lowest effective dose of ethinyl estradiol (usually 20mcg) and low-risk progestin if women are at higher VTE risk (obesity, over 39 years old).
- Adding Antiandrogens: If hirsutism persists after 6 months of monotherapy with an oral contraceptive, suggest adding an antiandrogen.
- Flutamide: Do not use flutamide due to hepatotoxicity.
- Combination Therapy: Combination therapy (estrogen-progestin and antiandrogen) is an option for severe hirsutism causing distress, but is not a standard first-line approach.
Other Drug Therapies
- Insulin-Lowering Drugs: Do not use insulin-lowering drugs for solely treating hirsutism.
- GnRH Agonists: Do not use GnRH agonists except for women with severe hyperandrogenemia (e.g., ovarian hyperthecosis) who do not respond well to OCs and antiandrogens.
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