Girsutizm – the excess growth of hair on a body and a face at women on men's (androgenic) type. It is characterized by emergence of hair in an upper lip, a chin, a thorax, on a back and a stomach. At a girsutizm violation of a regularity of a menstrual cycle, uterine bleedings, infertility, anemia is often observed. Easy degree of a girsutizm can not demand medical actions. Girsutizm of the expressed degree needs performing long-term treatment (from 6 to 12 months) and elimination of the reason ( or tumors of ovaries, tumors of adrenal glands, a hypophysis, Itsenko-Cushing's syndrome) for the termination of growth of hair. Various cosmetology ways help to get rid of the hair which are available in an undesirable zone to patients with a girsutizm.
Girsutizm – the excess growth of hair on a body and a face at women on men's (androgenic) type. It is characterized by emergence of hair in an upper lip, a chin, a thorax, on a back and a stomach. At a girsutizm violation of a regularity of a menstrual cycle, uterine bleedings, infertility, anemia is often observed. Demands long-term treatment (from 6 to 12 months) and elimination of the reason ( or tumors of ovaries, tumors of adrenal glands, a hypophysis, Itsenko-Cushing's syndrome) for the termination of growth of hair.
Girsutizm is observed approximately at 2-10% of women and can be so expressed that forces the woman to resort to various methods of mechanical removal of excess hair. At a girsutizm growth of the rough, pigmented rod hair in an androgen - the dependent zones having hypersensibility to male sex hormones – to androgens is observed: on a face, a breast, around a nipple areola, on a stomach, a back, hips. Girsutizm is not only a cosmetology problem, but also the evidence of existence in an organism of the serious pathological processes demanding correction from the gynecologist and the endocrinologist.
Girsutizm it is necessary to distinguish from a gipertrikhoz at whom growth of hair happens in an androgen - independent zones.
At a girsutizm the thin, soft, not pigmented pushkovy hair under the influence of a number of factors are transformed to terminal - long, rigid and pigmented. The giperandrogeniye, a family factor, collateral influence of drugs and idiopathic surplus of androgens most often occur among the reasons causing a girsutizm.
Giperandrogeniya, or the raised production of androgens (male sex hormones), can develop at the following states:
- disorders of yaichnikovy function at a syndrome of polycystous ovaries, new growths of ovaries, a gipertekoza of ovaries, a chronic anovulyation, a hypothalamic amenorea, etc. Girsutizm of an ovarialny origin is characterized by violations of a menstrual cycle, infertility, a hypertrophy of ovaries.
- disorders of function of adrenal glands at the congenital or acquired giperplaziya of bark of adrenal glands, tumors of adrenal glands, etc. Girsutizm of nadpochechnikovy genesis develops owing to the increased development by adrenal glands of steroid hormones, including androgens.
- disorders of hypophysial function at Itsenko's syndrome — Cushing, an akromegaliya, a prolaktinoma and so forth Girsutizm of a pituitarny origin is caused by primary damage of a hypophysis with further involvement of adrenal glands and is characterized by the increased secretion of cortisol and androgens.
Development family (or genetic) a girsutizm results from the genetic and chromosomal features which are observed throughout several generations in separate families or ethnic groups. More often the girsutizm is observed at the Caucasian and Mediterranean women, is more rare – at North European and Asian.
Reception of a number of medicines has the side effect development of a girsutizm. These are corticosteroids (a hydrocortisone, cortisol, etc.), anabolic medicines, progestins, androgens, streptomycin, acetazoleamide, interferon, , carbamazepine, etc.
Girsutizm called by the unknown reasons carries the name of an idiopathic syndrome of surplus of androgens. At an idiopathic girsutizm hypersensibility to androgens of receptors of skin and hair bulbs is observed. Manifestations of an idiopathic girsutizm are less expressed, hormonal deviations are insignificant, the menstrual cycle and reproductive function are usually not broken.
As the girsutizm reasons physiological and age conditions of the woman during which the shift in the ratio of estrogen and androgens (pregnancy, a postmenopause) is observed can also serve. In 90% of cases the girsutizm is caused by a syndrome of polycystous ovaries or an idiopathic syndrome.
Classification of a girsutizm
According to the reasons causing excess pilosis in endocrinology distinguish several clinical forms of a girsutizm:
- neuroendocrine: ovarialny, nadpochechnikovy, pituitarny girsutizm;
- dermatological or constitutional: family, idiopathic girsutizm;
- yatrogenny or exogenous – a medicinal and dependent girsutizm.
On degree of association of a girsutizm with other violations allocate:
- actually girsutizm;
- the girsutizm burdened by a hyperactive piloseboreyny complex (an acne, an acne disease etc.);
- girsutizm with violations of an ovulation;
- girsutizm in combination with virilization signs.
As the main manifestation of a girsutizm serves the men's type of pilosis at women, i.e. growth of the short, rigid, pigmented face, breast hair, around an areola of mammary glands, on a back, a stomach, the internal surfaces of hips, buttocks. Other signs of a girsutizm are strengthening of greasiness of skin and hair, an acne, an alopetion, as a result of the increased level of androgens. Often the girsutizm is followed by disorder of menstrual function (irregular periods, amenorey) and infertility.
Further at the girsutizm caused by a giperandrogeniya at women virilization signs, that is male lines quite often develop: muscle bulk increases, the voice grows coarse, baldness on temples develops, sexual desire amplifies, the sizes of mammary glands decrease, on men's type localization of fatty deposits on a body changes. Giperandrogeniya causes changes from female genitals: the clitoris increases, vulvar lips decrease, formation of vaginal lubricant stops.
Various quantitative systems of indicators are applied to assessment of expressiveness of manifestations of a girsutizm. Degree of pilosis of the person is estimated on a scale from "0" to "+4" where is "+1" an existence of hair over an upper lip or on a chin, and "+4" - well developed beard. On other scale of calculation degree of expressiveness of a girsutizm is determined by calculation:
- "hormonal number" (the score characterizing quantitative and high-quality growth of hair on a chin, an upper lip, a thorax and mammary glands top and a lower back, the top and lower half of a stomach, shoulders and hips);
- "indifferent number" (the score characterizing quantitative and high-quality growth of hair on a forearm and shin);
- "girsutny number" (the sums of "indifferent" and "hormonal" numbers at norm - less than 12 points, on average 4,5-4,6 points).
However, these estimated indicators are in many respects subjective and important only for assessment of dynamics of increase or reduction of growth of hair at the carried-out treatment or when progressing a disease.
The current of a girsutizm can be complicated by violations of menstrual function, infertility, pathological uterine bleedings, anemia. Girsutizm against the background of a polikistoz of ovaries is often combined with diabetes.
Diagnostics of a girsutizm
When collecting the anamnesis with a girsutizm it is necessary to find out the following factors from patients:
1. Nature of development of a disease:
- the gradual growth of hair on a body which is followed by emergence of an acne, increase of body weight, an irregularity of periods testifies in favor of a polikistoz of ovaries more often.
- the sharp development of a girsutizm which is followed by virilization signs to a thicket is observed at an androgen-sekretiruyushchikh tumors.
2. Medicinal anamnesis.
3. Nature of menstrual function. At patients with a regular menstrual cycle the girsutizm usually has idiopathic or family character and does not demand deep inspection.
For clarification of the nature of a girsutizm carry out laboratory tests, determining the content of the following hormones in blood serum:
- the general testosterone (at the content of testosterone 200 % - tumoral damage of ovaries);
- degidroepiandrosterona sulfate (DEA-S) - an indicator of activity of sekretorny function of adrenal glands (at concentration of DEA-S> 700 the % decreasing at dexamethasone reception suspect a giperplaziya of adrenal glands; the increased DEA-S level forces to think of tumoral processes in adrenal glands);
- androstendiona (increase in concentration of an androstendion is observed at pathology of ovaries);
- 17 hydroxyprogesterone - an intermediate metabolite of steroid hormones of adrenal glands (raises at congenital forms of a giperplaziya of adrenal glands);
- cortisol (concentration increases at Itsenko-Cushing's syndrome);
- gonadotrophins (concentration of LG increases in relation to FSG at a polikistoza of ovaries).
For clarification of the reasons of a girsutizm consultation of the gynecologist, ultrasonography of adrenal glands and ovaries, KT, MPT of adrenal glands and other bodies, brain MRT is held. For an exception of tumoral processes in ovaries the diagnostic laparoscopy is carried out.
Treatment of a girsutizm
The easy degree of a girsutizm which is not followed by violation of menstrual function does not demand special treatment. As the girsutizm, as a rule, is not an independent disease, but display of other pathology, its treatment is directed to elimination of primary etiologichesky factor (removal of tumors of adrenal glands, a hypophysis or ovaries, cancellation of the drugs causing growth of hair, treatment of a hypothyroidism, Itsenko's syndrome — Cushing or an akromegaliya etc.).
Medicinal therapy at a girsutizm appoint an androgen-sekretiruyushchikh of tumors after an exception. As most often the girsutizm is a consequence of a giperandrogeniya, purpose of the medicines of anti-androgenic action suppressing the level of testosterone and reducing sensitivity to androgens of hair bulbs is expedient.
At a congenital giperplaziya of adrenal glands cortisol, Prednisolonum or dexamethasone is applied. For suppression of excess formation of androgens at a polikistoza of ovaries appoint oral contraceptives, , clomifene. The treatment cycle takes with hormonal medicines from 3 to 6 months, sometimes cycles should be carried out repeatedly. It is necessary to consider existence of serious contraindications to treatment by anti-androgens at pregnancy, and also the fact that reception of these medicines prevents emergence of new hair, however does not reduce already available. At the girsutizm which is followed by excess weight, observance of a diet with the lowered content of carbohydrates is recommended to patients.
Cosmetology methods of treatment a girsutizm help to remove or make less noticeable undesirable hair. They include clarification, plucking out, shaving, a bioepilation wax or special creams, an epilation etc. Moderately expressed manifestations of a girsutizm mask decolouration of hair hydrogen peroxide. Constant plucking out and shaving of hair can cause formation of hems or skin infections. Chemical depilation is inefficient concerning thick and rough hair. The most effective method of disposal of hair at a girsutizm is the photoepilations or a laser epilation destroying a hair follicle and stopping growth of new hair.
The forecast at a girsutizm
At many women suffering from a girsutizm the serious psychological complexes disturbing full-fledged family and intimate life, complicating communication in society develop.
Treatment of a girsutizm long, the effect of reduction of growth of hair becomes swept up only in 6-12 months. At treatment of a girsutizm growth of new hair stops, however already available hair do not disappear. Therefore completely it is not possible to get rid of the excess growth of hair at a girsutizm though to slow down the speed of their growth quite really.