GROWTH ASSESSMENT / GROWTH DISORDERS (A GUIDE FOR PARENTS AND PATIENTS)

Long hair are believed to be a sign of femininity, a gem which women cherish. AB adorable as they seem you don't want to lose them. But these hair can be a social distress when they appear in some unwanted places.

Hirsutism is the condition of excessive hairiness on a females' body where normally females don't have hair. These women have male-pattern hair growth i.e pigmented coarse hair on cheeks, chin, back, etc. The result of this is excessive terminal hair* growth in areas where women generally have less or no hair. That make their appearance hairy. Thus these adorable beauties suffer a great social stigma that makes their life difficult. AB many people don't understand the reason behind these pattern of growth they tend to suspect some mysterious abnormality in these women. Though with all the social belief, scientific research acknowledging condition of these women might help these women have a better lifewith more dignity. Hirsutism is common in India as in other countries. In India it affects almost 5- 10%women of reproductive age.Hirsutism studies in India are comparatively low. Many women in India suffer psychological distress because of hirsutism. Hirsutism has been an embarrassment for many women especially because of the facial hair. It is classified into two types androgen induced and non androgen induced. Androgen induced as name suggests is due to excess of androgen. Non androgen induced include genetic or idiopathic hirsutism. Causes

In scientific terms hirsutism is result of excess of androgens (particularly elevated level of testosterone) or increased sensitivity to androgens, for example, in these women the hair follicles are extra sensitive to testosterone and produce abnormal hair growth even at low levels of the hormone. Hirsutism can also be a family trait as it has genetic origin though not always hereditary. The people in western countries in Middle east and Mediterranean areas are more common. Hirsutism can be a result of:

PREMENOPAUSE:

• Drug related: some drugs or medications used for treatment of certain diseases can cause hirsutism.

Example- Ingestion of anabolic steroid: the ingestion of this steroid

CAUSES HIRSUTISM.

• Ovarian: Ovarian tumor: Androgen secreting ovaries may cause cause hirsutism in some cases. This is a very rare cause of hirsutism. Poly cystic ovary syndrome: Hormonal imbalance of sex hormone in females. It is the most common cause of hirsutism. This condition can reduce fertility.

• Genetic: As the level of hormones is regulated by genes any abnormality in genetic function can cause hirsutism .

• Acromegaly: Excess of growth hormone acromegaly

• Idiopathic: Apart from these cases which exhibit some general cause of hirsutism. Hirsutism may be a result of unknown cases as well.

• Adrenal: Congenital Adrenal hyperplasia: This condition has a genetic origin resulting in abnormal production of steroid hormones which in turn causes hirsutism. Cushing's syndrome: Cortisol an essential element in body when produced in excess results in Cushing's syndrome.

Adrenal tumor: as rare as ovarian tumor Androgen secreting adrenal tumor is also a rare cause.

Post Menopause: Menopause causes lots of hormonal changes which may result in development of post menopause hirsutism. Hirsutism should not be neglected as it is not just limited to social stigma of abnormal hair growth. In severe cases hirsutism may lead to disorders such as ovarian or adrenal tumor

Symptoms

True hirsutism must be distinguisl]ed from hypertrichosis. Hypertri-chosis.is nothing but,"excessive growth of non-androgen responsive hair or vellus. Vellus are fine hair which are usually not pigmented. Hirsutism results in distinguishing coarse pigmented hair. Some other signs and symptoms are those related to excess of androgen-production giving masculine characters to females like:

• Hoarse voice or deepening ofvoice like in males.
• Balding along with excessive terminal hair.
• Female hormone is produced is low thus decreased breasf size is observed .
• As hair follicle are sensitive, in some cases acne is common in females with hirsutism
• Females with hirsutism have enlargement of clitoris
• Male character like muscle mass development also occur in females with hirsutism

Start noticing above symptoms if there is any abnormal hair growth on chest, neck, back, upper thighs seek Doctors' help. Some hair growth appear before or during menopause this might not be a sign of hirsutism as menopause can also result in unwanted hair growth which is not hirsutism. The thick, coarse hair growth and not fine excess hair symbolize hirsutism. Risk factors and Complications Some alarming factors that would help in early diagnosis include:

• Racial, cultural or ethnic background, people from places like South Asia, Middle East or South Asian ancestry are prone to have hirsutism.
• Women with hirsutism in their family background are also at more risk.

( Normal Levels)

Free testosterone in women :- 0.02 pgtml- 3.09 pg/ml 'Total testosterone level in women:- 14-76 ng/dl., Diagnosis

The diagnosis at physician include three stages of diagnosis one being objective diagnosis which include observation based diagnosis which begins with the physician checking for excessive hair on androgen dependent regions like face, chest, thighs, etc. Only dark black coarse hair and not fine thin hair symbolize hirsutism.

AB many people are born with excessive hair, the presence of excessive hair doesn't necessarily indicate hirsutism. So the concluding tests are also conducted. After physical examination a rating from zero to four is given based on hair growth on 9 prominent androgen dependent regions (Zero-less or no growth, Four - heavy coarse hair growth). The rating of this type is called subjective examination. Physician would ask about the associated symptoms like irregular periods, signs and symptoms of PCOS, occurrence of hirsutism sudden or not, etc.

After this examination there follows the third step of examination this includes all laboratory based test or imaging techniques. Blood test is done to detect the level of hormones like testosterone and 17a-hydroxyprogestrone is enough in many cases. To detect tumors ultra sound imaging can be used and CT scan can help know about adrenal gland. Cyst (fluid filled sacs) related to PCOS can also get detected by ultrasound scan. Urine test would help in detecting and determining level of cortisol.

TREATMENT

Different ways are adopted pharmacological and/or non pharmacological treatments are adopted for decent living with hirsutism. Some life style related options available for like youngwomen having hirsutism are:

• Oral contraceptives or pills containing estrogen and progesterone
• Anti androgen drugs
• Topical cream use for hair removal
• Laser therapy and electrolysis therapy are most effective therapy for permanent hair removal. This technique involves destruction of hair follicle by using laser and electric current respectively.

Domestic options like:

• Plucking hair
• Shaving which would help in quick hair removal
• Waxing using commercial waxing for removal of stray hair
• Chemical creams used for removal
• Some women bleach (a beauty treatment in parlors) the area with excess hair this changes color of skin and make them less visible

There are some contraindications during pregnancy so treatment should be strictly under observation of family . physician. More treatment options are developing as women are getting more conscious about their beauty. All these treatments would help women live with hirsutism. In case of women with PCOS insulin- sensitizing agents may prove useful.

Preventive measures are not available but early diagnosis would prove useful. All the medication should begin with the consultation of the medical professional and should be strictly under observation.