Constitutional Hirsutism

 CONSTITUTIONAL HIRSUTISM

 

Occasionally after a diagnostic evaluation for hirsutism, there is no explanation for the cause of the disorder. By exclusion, this condition is often called constitutional hir-sutism. Data support the hypothesis that women with con-stitutional hirsutism have greater activity of 5α-reductase than do unaffected women.

 

Treatment of constitutional hirsutism is primarily androgen blockade and mechanical removal of the excess hair. Spironolactone 100 mg/day is the most commonly used androgen blocker. Spironolactone also inhibits testos-terone production by the ovary and reduces 5α-reductase activity. Other androgen blockers include flutamide and cyproterone acetate. The activity of 5α-reductase can also be inhibited directly through the use of drugs such as finas-teride (5 mg orally daily). Eflornithine hydrochloride 13.9% is an irreversible inhibitor of L-ornithine decarboxy-lase, which slows and shrinks hair. This cream has been approved for facial use with satisfactory local effects. Patients taking an androgen receptor or 5α-reductase blocker should be placed on concomitant oral contracep-tives because of the teratogenic and demasculinizing effects on a fetus should pregnancy occur. Oral contraceptives may also improve the efficacy of these treatments through the decreased androgen and increased SHBG production effects associated with their use.

Comments

Post a Comment

Popular posts from this blog

The Postpartum Visit

  THE POSTPARTUM VISIT   At the time of the first postpartum visit, inquiries should be made into the following: status of breastfeeding, re-turn of menstruation, resumption of coital activity, use of contraception, interaction of the newborn with the fam-ily, and resumption of other physical activities such as return to work. Observation about and appropriate ques-tions concerning sadness and depression, anxiety, the par-ents’ concerns about infant care, and the relationship of mother and her partner are also part of the first postpar-tum visit. Involutional changes will have occurred in most instances. Inflammatory changes because of the healing of the cervix may result in minor atypia on a Pap smear performed at this time. Unless there is a history of signifi-cant cervical dysplasia, repeating the Pap smear in 3 months is appropriate.
Read more

Clinical Findings of Tubal Ectopic Pregnancy

  CLINICAL FINDINGS   Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.   Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38 ° C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tender...
Read more

Anxiety, Depression, and the Postpartum Period

Image
  ANXIETY, DEPRESSION, AND THE POSTPARTUM PERIOD   Although pregnancy and childbirth are usually joyous times, depression to some degree is actually common in the postpartum period. There is a wide spectrum of response to pregnancy and delivery, ranging from mild postpartum blues to postpartum depression (Table 11.2). Approximately 70% to 80% of women report feeling sad, anxious, or angry beginning 2–4 days after birth. These  postpartumblues  may come and go throughout the day, are usuallymild, and abate within 1 to 2 weeks. Supportive care and reassurance are helpful in ensuring that symptoms are self-limited. Approximately 10% to 15% of new mothers ex-perience  postpartum depression (PPD),  which is a more serious disorder and usually requires medication and counseling.  PPD differs from postpartum blues in the sever-ity and duration of symptoms.  Women with PPD have pro-nounced feelings of sadness, anxiety, and despair that interfere with acti...
Read more