Document 2 final
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
الصحة اجلنسية واإلجنابية للمراهقين والشباب 23<br />
Normal variant<br />
Symptomatic<br />
treatment<br />
with local<br />
measures<br />
Evaluation of Hirsutism<br />
رسم توضيحي رقم ١٠: تقييم حاالت الشعر الزائد<br />
Complaint of excessive hair growth<br />
History and physical examination<br />
No virilization<br />
Hirsutism<br />
Examine for virilization.<br />
Virilization present<br />
Full hormonal work-up<br />
(DHEAS, testosterone,17-OHP)<br />
Imaging studies<br />
Surgical exploration<br />
Hypertrichosis<br />
Use local<br />
measures.<br />
Discontinue<br />
offending<br />
pharmacologic<br />
agent.<br />
Menstrual history<br />
Irregular menses<br />
(anovulation)<br />
Normal<br />
Thyroid function<br />
tests<br />
Prolactin<br />
17-OHP<br />
and serum<br />
testosterone<br />
Serum<br />
testosterone<br />
17-OHP<br />
Abnormal<br />
Normal<br />
Normal<br />
Elevated<br />
≤200 ng<br />
per dL<br />
(6.94 nmol per L)<br />
≥ 200 ng<br />
per dL<br />
(6.94 nmol per L)<br />
≤200 ng<br />
per dL<br />
(6 nmol per L)<br />
≥200 ng<br />
per dL<br />
(6 nmol per L)<br />
Treat<br />
dysfunction.<br />
Consider CAH,<br />
PCOS,<br />
anovulation.<br />
Consider<br />
imaging of<br />
pituitary<br />
and/or<br />
ovaries.<br />
Anovulation<br />
Normal pelvic<br />
examination<br />
Imaging<br />
Surgical exploration<br />
Palpable<br />
adnexal<br />
mass<br />
Rules out<br />
adrenal<br />
hyperplasia/<br />
21-hydroxylase<br />
deficiency<br />
≤ 1,000 ng<br />
per dL<br />
(2.2 nmol per L)<br />
ACTH<br />
stimulation<br />
test<br />
≥ 1,000 ng<br />
per dL<br />
(2.2 nmol per L)<br />
Heterozygote<br />
carriers of<br />
21- hydroxylase<br />
deficiency<br />
Late-onset<br />
adrenal<br />
hyperplasia/<br />
21-hydroxylase<br />
deficiency<br />
Algorithm showing the evaluation of hirsutism. (ACTH = adrenocorticotropic hormone; CAH = congenital adrenal hyperplasia;<br />
DHEAS = dehydroepiandrosterone sulfate; PCOS = polysystic ovary syndrome; 17-OHP = 17 ∂-hydroxy-progesterone)
Change language