Hirsuitism

Question 1

What is the name of the scoring system for assessing Hirsutism?
What are the score ranges for normal, mild and mod-severe hirsutism?

Answer 1

Ferriman-Gallwey Score

<8: normal
8-14: mild hirsutism
>14: moderate to severe

Question 2

What twelve areas of the body are assessed for hirsutism in the Ferriman-Gallwey Score

Answer 2

Upper lip
Sideburn area
Chin
Lower jaw and heck
Upper back
Lower back
Upper arm
Thigh
Chest
Upper abdomen
Lower abdomen
Perineum 

All score 1-4

Question 3

Which three ethnic groups naturally have high scores in the Ferriman Gallwey Score?

Answer 3

Mediterranean
Hispanic
Middle Eastern

Normal if <9 (rather than 8)

Question 4

Which three ethnic groups naturally have low scores in the Ferriman Gallwey Score?

Answer 4

East Asian
Native American

Abnormal if >/=3 (rather than 8)

Question 5

What are the three pharmaceutical treatments for hirsutism?

Answer 5

COCP
- oestrogen and antiandrogenic progesterone:
- cyproterone, drospirenone or dienogest
Cyproterone
Spironolactone

Question 6

What % of women of reproductive age are affected by hirsutism?

Answer 6

5-10%

Question 7

What is the most common cause of hirsutism?

Answer 7

PCOS

Question 8

What are the two types of hair

Answer 8

1. Vellous: fine, soft and not pigmented

2. Terminal: long, coarse, pigmented

Question 9

What is hirsutism the result of?

Answer 9

The interaction between circulating serum androgens and the sensitivity of the hair follicle to androgens and local growth factors

Question 10

What effect do androgens have on hair?

They increase…

Answer 10

• hair follicle size
• hair fibre diameter
• proportion of time terminal hair spends in the anegen phase (growth phase)

Question 11

What are the causes / differential diagnosis of hirsutism?

Answer 11

PCOS: most common
CAH: non-classical
Adrenal or ovarian tumours: should be considered in older women, or women who have rapid / late onset hirsutism
Ovarian hyperthecosis: increased production of testosterone by luteinsed thecal cells in the stroma, leading to markedly increased serum testosterone concentrations
Cushings: excess secretion of adrenal androgens
Hyperprolactinaemia, acromegaly, hypothyroidism
Severe insulin resistance
Drugs: androgens, Danazol
Idiopathic

Question 12

What was the finding of the Cochrane Review looking at
MF vs COCP for hirsutism, acne and menstrual disorders in PCS?

2020

Answer 12

MF may be less effective in improving hirsutism compared to the OCP int he subgroup BMI 25-30, but uncertain in BMI <25 and >30

MF: increased GI side effects

Uncertain due to low quality evidence