Hirsutism

Hirsutism results from the change of hne, vellus hair to visible, thickened, terminal hair under the influence of dihydrotestosterone, a biologically active form of testosterone. This androgen-dependent hair growth develops in deflned patterns. Terminal hair is a normal phenomenon and is often found on the upper lip, the chin, aronnd the nipples and the midline of the lower abdomen. 

Patient distress is the prime indication for therapy. Drug treatment should be continued for 12 months before assessing response. Spironolactone is generally the drug tried first. Ovarian hormones, e.g., medroxyprogesterone acetate plus ethinyl estradiol, or cyproterone acetate plus ethinyl estradiol may be added if response is inadeqnate. 

Histamine is synthesized in enterochromaffln-like cells, mucosal mast cells, and nerves, according to the following reaction  

Histamine is metabolized by histamine A-methyltransferase to A-methylhistamine, which is then deaminated by monoamine oxidase type B into methylimidazole acetic acid. Histamine is also fonnd in platelets, lenkocytes, and basophils in the skin, Inngs, and gastric mucosa, as well as to a certain extent in blood, plasma, sputum, gastric juice, blister fluid, and pns. Histamine is stored mosfly in mast cells. 

Histamine may be used diagnostically to identify patients with pheochromocytoma (it increases the release of catecholamines) and to distinguish pernicious anemia (a lack of acid release indicates achlorhydria). 

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Phenytoin s absorption is slow and variable yet almost complete absorption eventually occurs after po dosing. More than 90% of the dmg is bound to plasma protein. Peak plasma concentrations are achieved in 1.5—3 h. Therapeutic plasma concentrations are 10—20 lg/mL but using fixed po doses, steady-state levels are achieved in 7—10 days. Phenytoin is metabolized in the fiver to inactive metabolites. The plasma half-life is approximately 22 h. Phenytoin is excreted primarily in the urine as inactive metabolites and <5% as unchanged dmg. It is also eliminated in the feces and in breast milk (1,2). Prolonged po use of phenytoin may result in hirsutism, gingival hyperplasia, and hypersensitivity reactions evidenced by skin rashes, blood dyscrasias, etc... 

Integumentary system—petechiae, ecchymosis, decreased wound healing, hirsutism (excessive growth of body hair), and acne ... 

Miscellaneous—hypersensitivity reactions, hypokalemia, hypernatremia, increased susceptibility to infection, cushingoid appearance (eg, moon face, buffalo hump, hirsutism), cataracts, and increased intraocular pressure. 

Impaired wound healing, thin fragile skin, petechiae, ecchymoses, erythema, increased sweating, suppression of skin test reactions, subcutaneous fat atrophy purpura, striae, hyperpig mentation, hirsutism, acneiform eruptions, urticaria, angioneurotic edema... 

Eplerenone 25 mg once 50 mg once baseline and within 1 week of initiation and dose titration Adverse effects gynecomastia or breast tenderness, menstrual changes, hirsutism... 

Cushing s disease and adrenal carcinomas cause adrenal androgen hypersecretion in high enough concentrations to result in signs of androgen excess (such as acne, menstrual irregularities, and hirsutism) and cause virilization in women.4... 

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

EF is a 45-year-old woman who presents to the dermatologist for evaluation of facial acne. She has a history of a 25 lb (11.36 kg) weight gain, irregular menses, and frequent vaginal yeast infections over the past 2 years. She complains of increased facial hair growth and lower extremity muscle weakness. Physical examination reveals facial acne, facial hirsutism, truncal obesity, thin skin, and purple abdominal striae. Her past medical history is significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, and rheumatoid arthritis. 

Excessive hair growth (hirsutism) and acne also may be present owing to relative androgen excess compared with low estrogen levels. 

Presence of acne, hirsutism, hair loss, or acanthosis nigricans may suggest androgen excess. 

Dermatologic Acne Diaphoresis Ecchymosis Hirsutism Impaired wound healing Petechiae Thin skin... 

Androgens Fluoxymesterone 10 mg orally twice a day Deepening voice, alopecia, hirsutism, facial/truncal acne, fluid retention, menstrual irregularities, cholestatic jaundice... 

Hirsutism Ichthyosis Abnormal, heavy hairiness A disease characterized by dryness, roughness, and scaliness of the skin caused by hypertrophy of the stratum comeum... 

Cyclosporine -immunosuppressant -nephrotoxicity -hirsutism -hepatotoxicity -tremor -anxiety -hypertension... 

Minoxidil Hirsutism, marked salt and water retention... 

Phenytoin Nystagmus, gingival hyperplasia, ataxia, hirsutism... 

The answer is g. (KatzungT pp 399-400J Phenytoin is one of the most commonly used antiepileptic agents. Chronic administration has been reported to cause adverse reactions, such as ataxia, dizziness, nystagmus, gingival hyperplasia, hirsutism, and megaloblastic anemia. 

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