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Hypertrichosis

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161. Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children. (Abstract)

to cyclosporin is probably less likely to result in hypertrichosis (3 studies, 140 children: RR 0.23, 95% CI 0.10 to 0.50) and gum hypertrophy (3 studies, 144 children: RR 0.09, 95% CI 0.07 to 0.42) (low certainty evidence). Levamisole compared with steroids or placebo may reduce the number of children with relapse during treatment (8 studies, 474 children: RR 0.52, 95% CI 0.33 to 0.82) (low certainty evidence). Levamisole compared to cyclophosphamide may make little or no difference to the risk for relapse

2020 Cochrane

162. Polycystic ovary syndrome

://jcem.endojournals.org/cgi/content/full/91/11/4237 http://www.ncbi.nlm.nih.gov/pubmed/16940456?tool=bestpractice.com Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. http://www.ncbi.nlm.nih.gov/pubmed/18950759?tool=bestpractice.com History and exam presence of risk factors female of reproductive age irregular menstruation infertility hirsutism acne overweight or obesity

2019 BMJ Best Practice

163. Acupuncture for polycystic ovarian syndrome. Full Text available with Trip Pro

Acupuncture for polycystic ovarian syndrome. Polycystic ovarian syndrome (PCOS) is characterised by the clinical signs of oligo-amenorrhoea, infertility and hirsutism. Conventional treatment of PCOS includes a range of oral pharmacological agents, lifestyle changes and surgical modalities. Beta-endorphin is present in the follicular fluid of both normal and polycystic ovaries. It was demonstrated that the beta-endorphin levels in ovarian follicular fluid of otherwise healthy women who were

2019 Cochrane

164. Management of Pilonidal Disease

-and-effect relationship, risk fac- tors associated with pilonidal disease include obesity, a sed- entary lifestyle, repetitive trauma or irritation to the gluteal cleft skin, familial history of pilonidal disease, and a hirsute body habitus. 2,3,8,9 Identification of these traits may direct counseling or aid in promoting lifestyle modifications. A positive family history of pilonidal disease is a risk factor for disease and may be associated with a higher recurrence rate after surgery. 10 Adjunctive

2020 American Society of Colon and Rectal Surgeons

166. FSRH Clinical Guideline: Combined Hormonal Contraception

health benefits B Use of CHC can reduce heavy menstrual bleeding (HMB) and menstrual pain and improve acne. C Use of CHC may be beneficial for women with premenstrual syndrome (PMS) symptoms. A Use of CHC (particularly continuous CHC regimens) can reduce risk of recurrence of endometriosis after surgical management. B CHC can be used for management of acne, hirsutism and menstrual irregularities associated with polycystic ovary syndrome (PCOS). C CHC use is associated with a significant reduction (...) , norgestimate* ? Newer/other: drospirenone (DRSP), dienogest, nomegestrol acetate (*sometimes classified as second generation: LNG is one of its active metabolites). Norelgestromin is a metabolite of norgestimate; etonogestrel is the active metabolite of desogestrel. Co-cyprindiol (containing 35 µg EE with cyproterone acetate, an anti-androgen) is indicated for management of moderate to severe acne and hirsutism. Women using co-cyprindiol for these indications do not require additional contraception. 9 5

2020 Faculty of Sexual & Reproductive Healthcare

167. Infertility: Scenario: Initial assessment of infertility

[painful periods]). Galactorrhoea or hirsutism. Systemic disease, including thyroid dysfunction, diabetes, and inflammatory bowel disease. Excessive exercise, weight loss, or psychological distress. History and symptoms that may indicate , including: Symptoms of pelvic inflammatory disease (PID) or endometriosis, such as dyspareunia (difficult or painful sexual intercourse) and dysmenorrhoea. See the CKS topics on and for more information. History of sexually transmitted infections (STIs) or PID (...) ) to assess for obesity (associated with lower fertility). See the CKS topic on for more information. Look for: Hirsutism and acne (associated with polycystic ovary syndrome). See the CKS topic on for more information. Galactorrhoea (suggestive of hyperprolactinaemia). Perform an abdominal examination to identify any mass, such as an ovarian cyst. Pelvic examination may identify vaginal infection or tenderness, indicating endometriosis or PID. Bimanual examination may reveal fibroids or an ovarian cyst

2020 NICE Clinical Knowledge Summaries

168. Testosterone Testing - Protocol

of oral contraceptive medications. In polycystic ovarian syndrome, total testosterone concentrations are within the normal reference interval or slightly higher. Consequently, testosterone concentrations greater than twice the upper limit of normal (i.e., greater than 5 nmol/L) suggest an alternate etiology, such as an androgen-secreting tumour. Signs and Symptoms of Hyperandrogenism in Women A range of symptoms and signs from hirsutism to virilisation may occur. The Endocrine Society recommends (...) testing for hyperandrogenism in women with hirsutism that is moderate or severe, of rapid onset, or accompanied by menstrual dysfunction, obesity or clitoromegaly. Other indications for referral are outlined at the end of this document. Testing for Hyperandrogenism in Women Serum total testosterone is frequently normal in women with mild clinical hyperandrogenism (due to androgen suppression of SHBG production). cBAT testing (which includes SHBG) has a better diagnostic yield for testosterone excess

2019 Clinical Practice Guidelines and Protocols in British Columbia

169. Cyproterone acetate: new advice to minimise risk of meningioma

to the Cyproterone acetate and risk of meningioma Cyproterone acetate is a synthetic progestogen with anti-androgenic activity. High-dose products containing 50–100 milligram (mg) are used in the treatment of prostate cancer (Cyprostat) and hypersexuality disorders (Androcur). Low-dose products containing 2mg cyproterone acetate in combination with 35 microgram (µg) ethinylestradiol (Dianette and Co-cyprindiol) are approved for use in the treatment of acne and hirsutism (see for full indications). There is also (...) evidence for off-label use of high-dose cyproterone as hormone therapy in gender reassignment and in female patients for conditions related to androgen sensitivity such as acne, hirsutism, and baldness. The association of high dose (50mg per day) cyproterone acetate with meningioma was first described in 2008 and a warning on the possible risk of meningioma together with a contraindication in patients with meningioma or a history of meningioma was added to the product information for high dose

2020 MHRA Drug Safety Update

170. Pilonidal sinus disease

involving other parts of the body, such as on the scalp, axilla, groin, and between the fingers). Opinions differ as to how it develops; the current consensus is that it is an acquired condition in which loose hairs in the natal cleft are driven into the natal skin, creating a chronic sinus tract which may become infected. Risk factors which make pilonidal sinus disease more likely include male gender, age 15–40 years, being white, hirsutism, and obesity. Active pilonidal sinus disease can progress

2020 NICE Clinical Knowledge Summaries

172. European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Symptoms and signs of hypogonadism LH FSH testosterone Androgen excess (women) Common Central obesity Irregular menses Hirsutism Acanthosis nigricans LH FSH oestradiol testosterone Cushing’s disease or Cushing’s syndrome Rare Central obesity Hypertension Type 2 diabetes 1 mg ODST Drug-induced endocrine dysfunction (e.g. lithium, anti-depressants, antipsychotics, glucocorticoids…) Common Psychiatric disorders Glucocorticoid therapy 1 mg ODST to exclude Cushing syndrome (except in glucocorticoid use

2020 European Society of Endocrinology

174. Obesity Prevention and Management

to weight gain, psychosocial factors, family history of obesity and related conditions [I D]. Physical exam focusing on: BP and heart rate, and signs of related comorbidities (acanthosis nigricans, hirsutism in women for example) [II B]. Psychosocial assessment: identify motivated patients and also barriers to weight management [II C]. Limited lab panel: lipid panel, glucose (or HgB A1C in adults), AST & ALT [II B]. Treatment Goal. For children, decrease rate of weight gain or 1-2 lb/week weight loss

2020 University of Michigan Health System

175. Overview of substance use disorders and overdose

in libido. The potential irreversible masculinising effects include hirsutism, male pattern baldness, deepening of the voice, and clitoral hypertrophy. Occurs by acute single ingestion of a large amount or by repeated ingestion of an amount exceeding the recommended dosage or by multiple doses. Poisoning may cause various degrees of liver injury including fulminant hepatic failure and hepatorenal syndrome. Patients are often asymptomatic or have only mild gastrointestinal symptoms at initial

2018 BMJ Best Practice

176. Polycystic ovary syndrome

://jcem.endojournals.org/cgi/content/full/91/11/4237 http://www.ncbi.nlm.nih.gov/pubmed/16940456?tool=bestpractice.com Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. http://www.ncbi.nlm.nih.gov/pubmed/18950759?tool=bestpractice.com History and exam presence of risk factors female of reproductive age irregular menstruation infertility hirsutism acne overweight or obesity

2018 BMJ Best Practice

177. Metabolic syndrome

its individual components regarding cardiovascular risk is greatly controversial. History and exam presence of risk factors hypertension increased BMI increased waist and hip circumferences type 2 DM non-alcoholic fatty liver disease angina claudication sleep disturbance, excessive daytime sleepiness, snoring, gasping breaths hyperuricaemia menstrual disturbances abdominal pain corneal arcus and xanthelasma hirsutism acanthosis nigricans acne hepatomegaly obesity insulin resistance physical

2018 BMJ Best Practice

178. Cushing's syndrome

or diabetes mellitus premature osteoporosis or unexplained fractures weight gain and central obesity acne psychiatric symptoms decreased libido easy bruisability weakness facial rounding dorsocervical fat pads unexplained nephrolithiasis hirsutism exogenous corticosteroid use pituitary adenoma adrenal adenoma adrenal carcinoma neuroendocrine tumours thoracic or bronchogenic carcinoma Diagnostic investigations urine pregnancy test serum glucose late-night salivary cortisol 1 mg overnight dexamethasone

2018 BMJ Best Practice

179. Anabolic steroid use disorder

effects of steroids increased weight gain and muscular build increased appetite aggression and mood swings hirsutism voice pitch alterations clitoral hypertrophy disproportionate muscular development of upper torso testicular atrophy acne and/or oily skin temporal hairline recession/male pattern baldness striae or keloids menstrual irregularities changes in libido scrotal pain impotence infertility premature masculinisation/feminisation (adolescents) cognitive impairment GI upset short stature

2018 BMJ Best Practice

180. Overview of substance use disorders and overdose

in libido. The potential irreversible masculinising effects include hirsutism, male pattern baldness, deepening of the voice, and clitoral hypertrophy. Occurs by acute single ingestion of a large amount or by repeated ingestion of an amount exceeding the recommended dosage or by multiple doses. Poisoning may cause various degrees of liver injury including fulminant hepatic failure and hepatorenal syndrome. Patients are often asymptomatic or have only mild gastrointestinal symptoms at initial

2018 BMJ Best Practice

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