Editing Hirsutism (section)

==Diagnosis==
Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth.<ref>{{Cite journal |last1=Ferriman |first1=D. |last2=Gallwey |first2=J. D. |date=November 1961 |title=Clinical assessment of body hair growth in women |url=https://pubmed.ncbi.nlm.nih.gov/13892577/ |journal=The Journal of Clinical Endocrinology and Metabolism |volume=21 |issue=11 |pages=1440–1447 |doi=10.1210/jcem-21-11-1440 |issn=0021-972X |pmid=13892577}}</ref> A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern [[virilization]].<ref name=":0">{{Cite journal|last=Sachdeva|first=Silonie|date=2010|title=Hirsutism: Evaluation and treatment|journal=Indian Journal of Dermatology|volume=55|issue=1|pages=3–7|doi=10.4103/0019-5154.60342|pmc=2856356|pmid=20418968 |doi-access=free }}</ref> One method of evaluating hirsutism is the [[Ferriman-Gallwey score|Ferriman-Gallwey Score]] which gives a score based on the amount and location of hair growth.<ref name="pmid13892577">{{cite journal |vauthors=Ferriman D, Gallwey JD |title=Clinical assessment of body hair growth in women |journal=J. Clin. Endocrinol. Metab. |volume=21 |issue=11 |pages=1440–7 |date=November 1961 |pmid=13892577 |doi=10.1210/jcem-21-11-1440 |url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=13892577 |access-date=2010-03-08 |archive-date=2021-08-28 |archive-url=https://web.archive.org/web/20210828111044/https://www.endocrine.org/journals/endocrine-press?view=long&pmid=13892577&view=long&pmid=13892577 |url-status=dead }}</ref> The Ferriman-Gallwey Score has various cutoffs due to variable expressivity of hair growth based on ethnic background.<ref>{{Cite journal |last1=Cheewadhanaraks |first1=Sopon |last2=Peeyananjarassri |first2=Krantarat |last3=Choksuchat |first3=Chainarong |date=May 2004 |title=Clinical diagnosis of hirsutism in Thai women |url=https://pubmed.ncbi.nlm.nih.gov/15222512/ |journal=Journal of the Medical Association of Thailand = Chotmaihet Thangphaet |volume=87 |issue=5 |pages=459–463 |issn=0125-2208 |pmid=15222512}}</ref><ref>{{Cite journal |last1=Escobar-Morreale |first1=H. F. |last2=Carmina |first2=E. |last3=Dewailly |first3=D. |last4=Gambineri |first4=A. |last5=Kelestimur |first5=F. |last6=Moghetti |first6=P. |last7=Pugeat |first7=M. |last8=Qiao |first8=J. |last9=Wijeyaratne |first9=C. N. |last10=Witchel |first10=S. F. |last11=Norman |first11=R. J. |date=March 2012 |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |journal=Human Reproduction Update |volume=18 |issue=2 |pages=146–170 |doi=10.1093/humupd/dmr042 |issn=1460-2369 |pmid=22064667|doi-access=free }}</ref>

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian [[Medical ultrasonography|ultrasound]], due to the high prevalence of [[polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]], as well as [[17α-hydroxyprogesterone]] (because of the possibility of finding non-classic [[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency|21-hydroxylase deficiency]]<ref name="pmid19338993">{{cite journal | vauthors = Di Fede G, Mansueto P, Pepe I, Rini GB, Carmina E | title = High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms | journal = Fertil. Steril. | volume = 94 | issue = 1 | pages = 194–7 | year = 2010 | pmid = 19338993 | doi = 10.1016/j.fertnstert.2009.02.056 | url = https://iris.unipa.it/bitstream/10447/36367/2/Fertility%20and%20Sterility%202010%2094%20194-7.pdf| hdl = 10447/36367 | hdl-access = free }}</ref>). People with hirsutism may present with an elevated serum [[Dehydroepiandrosterone sulfate|dehydroepiandrosterone sulfate (DHEA-S)]] level, however, additional imaging is required to discriminate between malignant and benign etiologies of adrenal hyperandrogenism.<ref>{{Cite journal |last1=d'Alva |first1=Catarina B. |last2=Abiven-Lepage |first2=Gwenaelle |last3=Viallon |first3=Vivian |last4=Groussin |first4=Lionel |last5=Dugue |first5=Marie Annick |last6=Bertagna |first6=Xavier |last7=Bertherat |first7=Jerôme |date=2008-11-01 |title=Sex steroids in androgen-secreting adrenocortical tumors: clinical and hormonal features in comparison with non-tumoral causes of androgen excess |url=https://eje.bioscientifica.com/view/journals/eje/159/5/641.xml |journal=European Journal of Endocrinology |language=en-US |volume=159 |issue=5 |pages=641–647 |doi=10.1530/EJE-08-0324 |pmid=18708437 |s2cid=6342456 |issn=0804-4643|doi-access= }}</ref>  Levels greater than 700 μg/dL are indicative of [[adrenal gland]] dysfunction, particularly [[congenital adrenal hyperplasia due to 21-hydroxylase deficiency]]. However, [[Polycystic ovary syndrome|PCOS]] and [[Idiopathic disease|idiopathic]] hirsutism make up 90% of cases.<ref name=":0"/>