For the purposes of this editorial, we are restricting our definition of hirsutism to an excess of terminal hair in a pattern not normal in the female patient. Affected areas include the upper lip, cheeks, chin, back, thighs, upper part of the arms, and central parts of the chest and lower parts of the abdomen. Clinically notable hirsutism in the past has often been attributed to normal variation or a familial tendency, but the development of more sensitive assay techniques has disclosed that the majority of patients with hirsutism do have an underlying abnormality of androgen metabolism. Several well-referenced reviews describe androgen metabolism and its abnormalities in hirsutism.1-5
In women, biosynthesis of androgenic steroids occurs only in the adrenal and the ovary. Ectopic neoplastic sources are unknown. Extraglandular conversions of androgenic precursors play an important role in their activation and function. Androgens differ from each other not only
Braithwaite SS, Jabamoni R. Hirsutism. Arch Dermatol. 1983;119(4):279–284. doi:10.1001/archderm.1983.01650280007005
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