Facial and body hair

Hirsutism is an excessive growth of coarse hair in the female on the face, trunk and limbs in the pattern normally seen in males. The pubic hair spreads from its normal Hat-topped distribution up towards the umbilicus, this being described as a male escutcheon. Mild hirsutism is a common condition, often associated with higher than average levels of testosterone. In some subjects it may be a cause of considerable psychological distress. Some increase in facial hair is common after the menopause.

Hirsutism associated with other signs of virilisation tthe development of masculine physical features in a female), including enlargement of the clitoris and menstrual irregularity or cessation, may be a sign of an androgen-secreting or pituitary tumour (Fig. 2.13 ).

Hypertrichosis is an excessive growth of eoarsc hair which does not follow an androgen-induced pattern. It may be due to many different causes including drugs

Pituitary Tumour
Fig. 2.13 56-year-old lady with virilisation secondary to bilateral ovarian hyperthecosis.
Panhypopituitarism Pictures

Weight loss Low volume pulse

Pubic/axillary hair toss Genital atrophy

Fig. 2.14 Panhypopituitarism in a woman.

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Obstetric history Menstrual pattern Sexuality Previous trauma Fatigue

Cold intolerance Thirst

Visual problems Headache

Visual field defect (suggests pituitary tumour) Pallor

Skin texture

Blood pressure (postural hypotension)

Breast atrophy

Weight loss Low volume pulse

Pubic/axillary hair toss Genital atrophy

Fig. 2.14 Panhypopituitarism in a woman.

(e.g. minoxidil and cyclosporin), trauma and cutaneous porphyria.

Secondary sexual hair on the face in the male, and in the axillae and on the pubis of both sexes, may fail to develop normally in hypogonadism; it may diminish in quantity in old age or be lost in hypopituitarism or as a result of hepatic cirrhosis. In severe hypopituitarism (Fig. 2.14) the loss is ultimately complete, including the hair follicles, so that the axillae and pubis return to the smooth appearance seen in childhood.

Eyebrows. The amount of hair in the eyebrows varies very widely. Thinning of the outer third of the eyebrows is so common in normal people as to be of little value in the diagnosis of hypothyroidism.

KEY POINTS

« Hirsutism is common, but is rarely associated with underlying disease.

• Thinning of the ouler third of the eyebrow is a common feature of normal subjects.

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