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Hirsutism - Management
Basis for recommendation

Underlying conditions

  • The recommendations to ask about, and look for, features of polycystic ovary syndrome (PCOS), androgen-secreting tumours, and Cushing's syndrome are based on the fact that these are known underlying causes of hirsutism.

Medication

  • Certain drugs, including danazol, sodium valproate, and anabolic steroids can cause hirsutism [Martin et al, 2008].

Investigations for mild hirsutism with no other signs of PCOS or other underlying condition

  • The recommendation that investigations are not necessary in women with mild hirsutism and no other signs of PCOS or other underlying condition is in line with recommendations from an Endocrine Society clinical practice guideline, based on very low quality evidence [Martin et al, 2008]. This is supported by the opinion of CKS expert reviewers.

Checking testosterone levels in women with moderate-to-severe hirsutism and no other signs of PCOS or other underlying condition

  • The recommendation to check testosterone levels in women with moderate-to-severe hirsutism and no other signs of PCOS or other underlying condition is in line with recommendations from an Endocrine Society clinical practice guideline, based on very low quality evidence [Martin et al, 2008].

Screening for late-onset congenital adrenal hyperplasia

  • The recommendation to consider screening for late-onset congenital adrenal hyperplasia in women at high risk is based on a narrative text on rational testing [Sathyapalan and Atkin, 2009].
    • Around 1–10% of women with hyperandrogenaemia have late-onset congenital hyperplasia, which is clinically indistinguishable from PCOS.
    • The prevalence is higher in Hispanic, Ashkenazi Jewish, and Slavic people. Therefore, screening in this group seems sensible.
    • Identification of late-onset congenital adrenal hyperplasia in women who are trying to conceive is important so that glucocorticoid treatment can be initiated in the peri-conceptual period [Koulouri and Conway, 2009].

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