Excessive hair
Introduction
Introduction Excessive hair is one of the symptoms of hirsutism. Congenital, it includes four properties of hirsutism, premature development, male malformation and primary hirsutism. Primary hirsutism is caused by hair follicles allergic to endogenous androgens or increased dihydrohydrotestosterone in the periphery. Acquired by diseases and drugs.
Cause
Cause
(1) Causes of the disease
1. Congenital. It includes four properties: hirsutism, premature development, male malformation and primary hirsutism. Primary hirsutism is caused by hair follicles allergic to endogenous androgens or increased dihydrohydrotestosterone in the periphery.
2. Cerebral and hypothalamic lesions, such as encephalitis caused by encephalitis, multiple sclerosis, and intracranial hyperplasia.
3. Pituitary hirsutism, such as acromegaly, diabetes, basophilic tumor (secondary hypercortisolism) may cause hirsutism.
4. A hirsutism caused by a younger type of hypothyroidism.
5. Adrenal glandular syndrome and hirsutism caused by hypercortisolism.
6. Menopausal or women with polycystic ovary or with follicular hyperplasia and ovarian tumors may have a lot of hair.
7. Because of the use of exogenous drugs (such as androgen, phenytoin, synthetic progesterone, cortisone), pregnancy, puberty caused by mental anorexia, mental stress or local irritation.
Among the many causes, adrenal adenomas, ovarian tumors, polycystic ovary, follicular hyperplasia, and primary hirsutism are the most common.
(two) pathogenesis
Familial hereditary hirsutism
A hirsutism can be caused by an increase in plasma testosterone levels or an increase in testosterone in the hair follicles to dihydrotestosterone. In female patients with familial hereditary hirsutism, the body hair is slightly more than normal, thin and long, distributed as male, may be hair follicles sensitive to androgen, receptor-rich, normal amount of androgen or exogenous to the body Both small doses of androgen can cause hirsutism.
2. Adrenal hirsutism
(1) Adrenal tumors: Adrenal adenomas or adrenocortical carcinomas can synthesize androgen androgen, such as androstenedione, dehydroepiandrosterone and testosterone, causing hirsutism and masculinization.
(2) Cushing's disease: increased ACTH secretion causes bilateral adrenal hyperplasia, hypercortisolism, ACTH is mostly derived from pituitary basophils or chromophobe cells, less from ectopic ACTH syndrome, ie Some malignant tumors such as lung cancer. Adrenal hyperplasia often secretes the growth of adrenal androgen, which causes amenorrhea, hairy and masculine performance in women.
(3) masculinization of congenital adrenal hyperplasia: adrenal P450 C2l-hydroxylase deficiency, P450 C11-hydroxylase deficiency and 3-HSD deficiency, adrenal cortisol synthesis disorders and reduction, can cause ACTH compensatory secretion Increased, leading to excessive androgen secretion and adrenal hyperplasia, young female patients may have varying degrees of hirsutism and masculine manifestations, that is, amenorrhea, larynx and low voice and other abnormalities.
3. Central hirsutism
(1) cerebral hirsutism: after brain damage such as encephalitis, multiple sclerosis, pineal tumors and intracranial hyperplasia, some patients may have increased androgen secretion, and induced hirsutism.
(2) hypothalamic and pituitary hirsutism: hypothalamic and pituitary tumors, pituitary eosinophilic adenoma, basophil hyperplasia and adenoma, etc., can cause adrenal hyperplasia, and cause hirsutism, acromegaly Symptoms can also have hirsutism.
4. Ovarian hirsutism
(1) Polycystic ovary syndrome: is the cause of more common hirsutism, may be associated with clitoris hypertrophy. Due to the inhibition of aromatase, 3-hydroxysteroid dehydrogenase and the enhancement of P450C, 17 and 20-lyase activity in polycystic ovary, the follicular cells proliferate, and the synthesis of androgens increases, resulting in hirsutism and masculinization.
(2) ovarian tumors: such as ovarian germ cell tumor, portal cell tumor, ovarian cord tumor and adrenal residual cell tumor can synthesize and secrete androgen, causing hirsutism and masculinity.
5. Drug-induced hirsutism
Some drugs, such as phenytoin, diazoxide, minoxidil and cyclosporine in non-hormonal drugs, hormone drugs such as prednisone, etc. take too long, can cause hirsutism when the dose is large.
6. Insulin resistance syndrome and hirsutism
There are three types of insulin resistance syndrome caused by hereditary insulin receptor deficiency: 1 insulin resistance type A, its clinical manifestations include diabetes, acanthosis nigricans and androgen levels; 2 adipose atrophic diabetes can have diabetes, lipoatrophy Increased triglycerides, acanthosis nigricans and androgen levels; 3 dwarfism manifested in intrauterine growth arrest, fasting hypoglycemia, dwarfism and androgen levels. These hyperinsulinemia can cause the proliferation of follicular cells and the synthesis and secretion of androgen, resulting in hirsutism and masculinity.
7. Idiopathic hirsutism
Clinically, the patient has no genetic family history, no organic disease, no medication history, the main manifestations of hirsutism can not find the cause, and the examination is also normal, such patients are idiopathic hirsutism.
Examine
an examination
Related inspection
Hair abdomen body hair examination hair minerals check sweat electrolyte check
The most sensitive sign of excessive androgen production is hairy, then acne, oily skin, increased libido, clitoris hypertrophy, and finally masculine, masculine more suggestive of tumor.
Acne is another sign of excessive androgen. Although many testosterone levels in acne patients are not high, there is evidence of an increase in 5-reductase. Hair loss is also one of the clinical manifestations, with 40% of off-patients having hyperandrogenism.
Patients with hyperandrogenism should pay special attention to the presence of acanthosis nigricans.
The hairiness that occurs during pregnancy is often caused by flavin tumors and disappears after childbirth. The only danger is that it may lead to masculinization of female fetuses. There is very little chance of pregnancy with ovarian functional tumors, as the latter are not prone to pregnancy.
When asking about medical history and physical examination, attention should be paid to the degree of hairiness and the rate of development of hairy hair, which is related to tumors. Should also pay attention to whether there are acromegaly and other manifestations of Cushing's syndrome, and should pay special attention to the history of medication: such as danazol; the compound preparation for the treatment of climacteric syndrome may also contain a small amount of androgen; other such as phenytoin Sodium, minoxidil, chlorpromazine and diazoxide.
For patients with hairy hair, special attention should be paid to menstrual problems. For young women, long-term irregular menstruation and slow progression of hairy hair, the most likely diagnosis is ovarian hairiness caused by anovulation.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Hairy hair that occurs during pregnancy
In addition to hairy, women without other symptoms and signs of endocrine dysfunction are called idiopathic women with hirsutism, mainly in pregnant women and menopausal women. During pregnancy, a series of physiological endocrine changes occur in women, in which the anterior pituitary gland secretes more adrenocorticotropic hormone and gonadotropin, which causes an increase in adrenocortical hormone and androgen secreted by the ovaries and adrenal glands. Excessive androgenic hormones prolong the growth of the hair, and the hair is therefore longer than usual; at the same time, the number of hairs can be increased, so that hairy can occur early in pregnancy. This disease is a type of hirsutism in idiopathic women.
2. Ovarian hairy
Ovarian hairy hair is a type of hirsutism. Hypertrichosis generally refers to the excessive growth and distribution of female hair. It is the increase of androgen in the blood circulation including testosterone, dihydrotestosterone, androstenedione, dehydroepiandrosterone and dehydroepiandrosterone sulfate. . Clinically, female sexual characteristics can be overgrown and the distribution is masculine. Mainly manifested in the face, ears, around the mouth, chest, around the nipple, armpits, back, lower abdomen, pubic hair more dense, diamond-shaped distribution to the umbilicus, and the lower extremities and the front of the thigh, often accompanied by irregular menstruation, cold Wait. Female hairy is often considered to have a certain masculine disease and psychological pressure to seek treatment.
3. The lumbosacral skin is hairy and abnormally pigmented
Patients with tethered cord syndrome, especially children, should be alert to a clinical manifestation of this disease: the lumbosacral skin is hairy and abnormally pigmented. Tethered cord syndrome (TCS) is a syndrome in which a spinal cord or a cone is pulled due to various congenital and acquired causes, resulting in a series of neurological dysfunctions and malformations. Because the spinal cord is pulled more often in the lumbosacral medulla, causing the cone to be abnormally low, it is also called the lower spinal cord.
4. Facial hairy
Facial hairiness means that the hair density increases and becomes longer and longer. It exceeds the normal physiological range. Generally, the facial, genital, armpit, abdomen, back and limbs are obviously increased in growth and thickening, and some are long beards, chest hairs and nipples. Long hair, often accompanied by irregular menstruation, cold and so on.
After entering adolescence, the girl gradually grows long hair, which is normal. However, there are some young girls who have long hairs on their arms, legs, face, back, etc., which are rubbed with a cream that is specially used to remove hair. I hope to return to normal, but it is useless, but grows longer and more. blacken. In the summer, I am even embarrassed to wear short-sleeved clothes and skirts.
The most sensitive sign of excessive androgen production is hairy, then acne, oily skin, increased libido, clitoris hypertrophy, and finally masculine, masculine more suggestive of tumor.
Acne is another sign of excessive androgen. Although many testosterone levels in acne patients are not high, there is evidence of an increase in 5-reductase. Hair loss is also one of the clinical manifestations, with 40% of off-patients having hyperandrogenism.
Patients with hyperandrogenism should pay special attention to the presence of acanthosis nigricans.
The hairiness that occurs during pregnancy is often caused by flavin tumors and disappears after childbirth. The only danger is that it may lead to masculinization of female fetuses. There is very little chance of pregnancy with ovarian functional tumors, as the latter are not prone to pregnancy.
When asking about medical history and physical examination, attention should be paid to the degree of hairiness and the rate of development of hairy hair, which is related to tumors. Should also pay attention to whether there are acromegaly and other manifestations of Cushing's syndrome, and should pay special attention to the history of medication: such as danazol; the compound preparation for the treatment of climacteric syndrome may also contain a small amount of androgen; other such as phenytoin Sodium, minoxidil, chlorpromazine and diazoxide.
For patients with hairy hair, special attention should be paid to menstrual problems. For young women, long-term irregular menstruation and slow progression of hairy hair, the most likely diagnosis is ovarian hairiness caused by anovulation.
