What is the clinical history of patients with hirsutism?

Updated: May 01, 2020
  • Author: George T Griffing, MD; Chief Editor: Michel E Rivlin, MD  more...
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An accurate history of the patient's onset of hirsutism and developmental milestones can be helpful in the etiologic diagnosis.

  • Age of onset

    • Idiopathic hirsutism and the other less-serious causes of hirsutism usually begin at puberty.

    • Conversely, hirsutism that occurs in middle-aged or older women should suggest an adrenal or ovarian tumor.

  • Family history: A patient with a family history of hirsutism is consistent with congenital adrenal hyperplasia (CAH); however, idiopathic hirsutism and polycystic ovary syndrome (PCOS) can also be familial. See presentation in the image below.

    The photograph depicts familial hirsutism in a Pak The photograph depicts familial hirsutism in a Pakistani woman.
  • Hirsutism severity and rate of progression

    • The history of a benign form of hirsutism is usually characterized by pubertal onset with slow progression over many years. This is often true of hirsutism with PCOS.

    • When a history of rapid severe hirsutism or other signs of virilization are obtained, an androgen-secreting tumor is a possibility.

  • Adrenarche and puberty

    • Because the development of pubic hair depends on adrenal androgens, early development points toward CAH.

    • In contrast, ovarian hyperandrogenism is associated with normal adrenarche and delayed menarche or irregular menses.

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