pubic hair loss
Introduction
Introduction Like hair, pubic hair can also fall off due to metabolism. The pubic hair is replaced approximately every six months, with about 10-20 drops per day. As the age increases, the secretion of sex hormones gradually decreases, the hair follicles gradually shrink, the pubic hairs fall off, the pubic hair becomes gradually rare, and turns from black to white, which are normal physiological phenomena. Before and after menopause, the rate of pubic hair loss is accelerated. If there is no special abnormality, it is also physiological. You don't have to worry about it. However, some people have severe pubic hair loss in adulthood and even in adolescence, most of which are caused by certain diseases. In women, the most common cause of pubic hair loss is pituitary prolactinoma and anterior pituitary dysfunction. The former can occur at any age, the latter is more common in women with postpartum hemorrhage, both of which are in the pituitary gland. In the case of pituitary prolactinoma, the concentration of prolactin in the blood will increase, and in addition to the closed milk, the mane and pubic hair will fall off.
Cause
Cause
Due to postpartum hemorrhage, especially with long-term hemorrhagic shock, the pituitary tissue is hypoxic, degeneration and necrosis, followed by fibrosis, which eventually leads to a syndrome of hypopituitarism, which accounts for postpartum hemorrhage and hemorrhagic shock patients. About 25%. Studies in recent years have shown that the occurrence of Sheehan's syndrome is not only related to hypopituitarism, Otsuka reported that 40% of patients showed signs of hypofunction of the whole pituitary gland, 50% of which showed neurohypophyseal function There are also varying degrees of anomalies.
Examine
an examination
Related inspection
Abdominal body hair examination prolactin (PRL) excitatory test
With a history of postpartum hemorrhage or a history of shock, the above-mentioned typical clinical manifestations and signs can be diagnosed in combination with laboratory tests.
Laboratory inspection:
1. Pituitary hormone test: GH, FSH, LH, ACTH, PRL decreased.
2. Thyroid hormone detection: TT3, TT4, T3, T4, TSH are reduced.
3. Adrenal hormone test: Cortisol, urine 17-hydroxyl, 17-ketone decreased, fasting blood glucose decreased.
4. Sex hormone detection: estrogen, progesterone, testosterone propionate are reduced.
5. Blood routine: Hemoglobin, red blood cells, and hematocrit decrease.
6. Immunological tests: The occurrence of Sheehan syndrome has not been confirmed to be related to autoimmunity. Immunological tests have shown that patients with blood tests are negative for pituitary antibodies and negative for pituitary peroxidase antibodies.
7. Determination of pituitary reserve function:
(1) Thyrotropin-releasing hormone (TRH) stimulation test: The principle is that TRH can stimulate the production of TSH and PRL in the anterior pituitary, and the TRH l00200g is dissolved in 2ml of normal saline intravenously, respectively, before and after injection. At 30 and 60 min, 3 ml of blood was drawn, and the base values of TSH and PRL and the change of the value after administration were measured. RESULTS: TSH peaked at 20 to 30 minutes after injection, and the peak value was 6.5 to 20.5 min/L. If there was no significant increase after injection of TRH, it indicated that the pituitary reserve function was insufficient. The PRL basal level was <25g/L, which increased to 40g/L 30min after injection of TRH. If there is no obvious increase or increase, it is not obvious, suggesting that the pituitary function is insufficient.
(2) Luteinizing hormone-releasing hormone (LH) stimulation test: using LHRH 50-100g dissolved in 5ml saline, intravenous bolus injection, respectively, before injection and 15, 30, 60, 90min after injection, 3ml, using radioimmunoassay The method measures FSH and LH. FSH and LH increased by 2 to 4 times 30 min after normal injection. If there is no response, the function of pituitary gland is poor.
8. Other blood tests: lower blood sugar, lower hemoglobin, and higher eosinophils.
Other auxiliary inspections:
1. Imaging examination: Ultrasound examination shows uterine atrophy, ovarian small, no follicular development, and no ovulation. The cranial X-ray showed no significant changes in the sella. The CT and MRI of the brain showed that the pituitary atrophy became smaller. MRI showed that 83% of the patients had a significant reduction in the density even though the pituitary image was identifiable, even showing the cavity echo in the sellar region. It is called "empty saddle".
2. Other: The basal body temperature drops, showing a single phase. Electrocardiogram, echocardiography, and cardiac function tests may have manifestations of myocardial ischemia.
3. Vaginal smear: shows low levels of estrogen.
4. Urine examination: 17-KS, 17-OH in urine was significantly reduced in 24 hours.
Diagnosis
Differential diagnosis
Symptom identification of pubic hair loss
1, prolactinoma: is the most common pituitary tumor, endocrine disease caused by excessive prolactin (PRL) secretion from pituitary prolactinoma, clinically with high prolactinemia, galactorrhea or galactorrhea-menopausal syndrome as the main performance . More common in women between the ages of 20 and 30, men are rare.
2, Xi Han syndrome: anterior pituitary dysfunction, also known as Xi Han syndrome, Xi Han syndrome is a common pituitary disease, occurs in women in the reproductive period, and more often have a history of postpartum hemorrhage and shock history. Shehan syndrome can occur not only in vaginal delivery but also after cesarean section. In Xihan syndrome, the gonadal function is reduced, the female ovary is significantly reduced, and the uterus and mammary gland are atrophied.
3, primary hypothyroidism: primary hypothyroidism, in addition to thyroid function, other endocrine gland function may also be low, and thus can be mistaken for hypopituitarism. The identification of the two is more obvious in the appearance of mucinous edema of primary hypothyroidism, and the blood cholesterol concentration is more obvious, and the heart tends to expand. TSH stimulation test: primary hypothyroidism TSH overreaction, hypogland hypofunction can be no TSH elevated response, hypothalamic is delayed response. The most discriminating value is the determination of thyroid stimulating hormone in plasma, which is elevated in primary hypothyroidism and undetectable in hypopituitarism.
4, chronic adrenal insufficiency: the difference between chronic adrenal insufficiency and pituitary hypofunction is: the former has typical skin, mucosal pigmentation, and sexual organ atrophy and hypothyroidism are not obvious, promote Adrenal cortex hormones do not respond, and sodium loss is more serious.
5, autoimmune multiple endocrine glands: in this patient, there are a variety of endocrine gland dysfunction, but the cause is not due to pituitary dysfunction, but due to multiple endocrine gland primary dysfunction, and gland The identification of pituitary dysfunction is mainly based on the adrenocorticotropic hormone and thyroid stimulating hormone excitatory test. In this group, there is no response, and in the pituitary hypofunction, there is often a delayed response.
