Hirsutism is defined as the presence of terminal coarse hairs in females in a male-like distribution. It affects around 5-10% of women globally. Hirsutism represents a primary clinical indicator of androgen excess. Although most common cause of hirsutism is PCOS, that may not be the case with every patient.
• 17 OH Progesterone
• Androsteindione
• D H E A S
• Di HydroTestosterone
• Free Androgen Index (FAI)
• Free Testosterone
• FSH/LH/Prolactin
• TSH
17 OH Progesterone
This test measures blood 17-OHP levels. This serum marker is unique for congenital adrenal hyperplasia that occurs due to decreased adrenal cortisol and aldosterone and increased male sex hormone (androgen) production.
Androsteindione
This test determines level of Androstenedione in blood. One of several male sex hormones, Androstenedione is an androgen. It causes onset of sexual differentiation in females and males and the development of secondary male physical characteristics. Produced by the ovaries in women, the testicles in men, and by the adrenal glands in both.
D H E A S
This test measures the level of Dehydroepiandrosterone sulfate (DHEAS) in blood. DHEAS is an androgen that is present in both men and women. Raised DHEAS (>700 μg/dl) always indicates an adrenal cause, benign or malignant.
Di HydroTestosterone
Women with too much dihydrotestosterone may develop increased body, facial and pubic hair growth (called hirsutism), stopping of menstrual periods (amenorrhoea) and increased acne. DHT is the primary androgen responsible for hair growth, synthesized from testosterone through enzyme 5α-reductase type 2. Hirsute females have increased 5α-reductase-activity in hair follicles.
Free Androgen Index (FAI)
The percentage ratio of total testosterone to SHBG concentration is called free androgen index (FAI). Research suggest Free androgen index may be a useful marker in hirsutism and PCOS instead of free testosterone, due to technical methodological difficulties (Kindi et al., 2012).
Free Testosterone
In women, testosterone levels are normally low. Increased testosterone levels can indicate PCOS, Ovarian or adrenal gland tumor, Congenital adrenal hyperplasia. Serum testosterone may be normal to increased in case of benign pathology as PCOS and CAH but would be definitely raised (>200 ng/ml) in case of malignant tumor of the adrenal or ovary.
FSH/LH/Prolactin
LH/FSH greater than 3 is indicative of PCOS. Prolactin would be raised in hyperprolactinemia due to hypothalamic disease or a pituitary tumor.
Serum TSH
Hypophyseal hypothyroidism can act as a cofactor in hirsutism causing raised TSH.
Ref.
• Al Kindi MK, Al Essry FS, Al Essry FS, Mula-Abed W-AS. Validity of Serum Testosterone, Free Androgen Index, and Calculated Free Testosterone in Women with Suspected Hyperandrogenism. Oman Medical Journal. 2012;27(6):471-474.
• Kopera D, Wehr E, Obermayer-Pietsch B. Endocrinology of Hirsutism. International Journal of Trichology. 2010;2(1):30-35.
