Senin, Juni 06, 2011

Hirsutism

Have you ever heard the term hirsutism? 
Hirsutism is a condition where there is excessive hair growth in places that should not normally occur in women. Obviously this is very disturbing appearance. Why does this happen? Some of the factors that led to the emergence of hisrutisme namely excessive androgen production, increased sensitivity of hair follicles to androgens and increased conversion or change of androgens. These three factors are often found on the circumstances Congenital Adrenal hyperplasia (CAH), Adrenal adenomas or carcinomas, Cushing's disease, polycystic ovaries (72%), ovarian tumors, the effects of drugs such as minoksidil, phenytoin, steroid medication (oral contraceptive pill, DHEA), hirsutism idiopathic. 




To find out if someone is having hirsutism can use methods like the picture below.Score Ferriman-galwey assess the level of hirsutism hirsutism appropriate level and are valued at the sum of the numbers from 1 to 4. hirsutism say if the score is more than 6. 




Laboratory tests to determine the cause of hirsutism is: 


  • Testosterone is a parameter of adrenal and ovarian activity 
  • DHAS is a parameter of adrenal activity 
  • 3α-AG (glukoronida androstenediol) is a parameter of activity of peripheral target tissues 

With the increase in ovarian androgen secretion, the serum testosterone levels increased so that spur 5α-reductase activity resulted in the formation of DHT increases.DHT is what causes the change of vellus to terminal hair. 

There are various ways of treatment that can be selected as follows: 

The combination of hormonal suppression (oral contraceptives, long acting GnRH analogue and insulin) 
Peripheral antiandrogens (spironolactone, flutamide, cyproterone acetate, or finasteride) 
Electrolysis and laser hair cutting 

Medications used to treat hisrutisme 
Cyproterone acetate 
Is a androgen receptor antagonist first work through competition with DHT for binding to the androgen receptor and reducing the activity of 5a-reductase in the skin. These drugs have other effects in the form of contraceptive effects (prevent pregnancy) through the inhibition of gonadotropin secretion resulting in suppression of ovarian testosterone secretion. The drug is given 50-100 mg / day on days 1-10 of the menstrual cycle, combined with oral estrogen on days 1-21 of the menstrual cycle and proven effective in 50-74% female hirsutism. Side effects that may arise in the form of decreased libido, mental depression, and hepatotoxic (rare) 

Finasteride 
It is the latest work by mengambat antiandrogenik 5α-reductase activity of type 2 and blocks conversion of testosterone into dihydrotestosterone. The success of this therapy is 21-45% with therapy. Oral dose of 5 mg / day, 3 months to 1 year. Very minimal side effects: headache, gastrointestinal disturbances, and the increase in total testosterone 

Spironolactone 
This drug is an aldosterone antagonist as a diuretic in hypertension therapy. Besides having a diuretic effect of these drugs also have effects on peripheral antiandrogenik hair follicles. This drug occupies androgen receptors thereby replacing DHT in cytosol receptor. These drugs also inhibit the cytochrome P450 monooxygenase that biosynthesis of androgens decreased and finally decreased testosterone levels. Dose of 200 mg per day of administration. Side effects that may arise while diuresis, polidipsi, menstrual cycle disorders, breast tension, and fatigue. 

Flutamide 
Is a potent nonsteroidal antiandrogen on the level of receptor-specific. The advantage of this drug is the absence of side effects or intrinsic hormonal activity antigonadotropin. Dose of 250 mg 1-3 times a day is very effective for the treatment of moderate to severe hirsutism side effects: hepatotoxicity, decreased appetite, amenorrhea, decreased libido, or dry skin, teratogenic 
From several studies on the use of these drugs over the long-term therapy (6 months to a year), there is little clinical difference in efficacy of drugs used to treat hirsutism (drug oral contraceptives, spironolactone, flutamide and finasteride). Can not be concluded that one of antiandrogens were better than others. Options depend on the cost and side effects


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