Congenital Adrenal Hyperplasia (CAH) Tips

There are women who feel their looks are spoilt because of the presence of excessive body hair. While hair on women's body is common, excessive body hair isn't a normal condition and must be taken seriously. Women are generally unaware that the condition is known as Hirsutism.

What is Hirsutism?

Hirsutism can be defined as growth of excessive facial and body hair in women. With the world obsessed with flawless skin, such changes from feminine hair pattern (soft, fine, vellus hair) to masculine hair pattern (hard, dark, terminal hair) in a woman is generally unwelcoming and, hence, very distressing for the woman.

Why do some women develop Hirsutism?

In order to understand the reasons for such excessive growth in some women, it is important to understand the differences in the physiology of men and women. The male or female appearance of one's body is dependent on a delicate balance between male and female sex hormones. There is a predominance of the hormone estrogen in a woman's body, whereas androgens (testosterone) are the predominant sex hormones among men. However, some amount of androgens is secreted by the ovaries and adrenal glands (located next to kidneys) in women also. But, an excessive production of these hormones results in Hirsutism. Hormonal imbalance is by far the most common cause of Hirsutism.

Causes of Hirsutism

The common causes of hirsutism include:

1. Endocrine causes

• Polycystic Ovarian Syndrome (PCOS) - PCOS is a condition of hormonal imbalance in the body, which can result in an irregular menstrual cycle, enlarged ovaries with a cystic appearance on USG, infertility, obesity and hirsutism. For more information on the causes and management of PCOS.
• Cushing's syndrome - Excessive production of hormone Cortisol by the adrenal glands can lead to symptoms such as high blood pressure, abdominal obesity, skin discoloration, muscle weakness, irregular menstruation, and hirsutism etc. This syndrome is known as Cushing's syndrome.
• Congenital Adrenal Hyperplasia (CAH) - CAH is a condition of excessive production of hormones Androgens and Cortisol by the adrenal glands and generally manifests in childhood in the form of virilization. In such cases, CAH can present with symptoms such as ambiguous genitals, obesity, hypertension etc. However, sometimes the manifestation of CAH is deferred to early adulthood and results in milder symptoms, hirsutism being one of them.

2. Tumors - Tumors in ovary or adrenal glands can again cause hirsutism due to excessive production of androgens

3. Medications

• Long term steroid consumption (commonly used for immunosuppression, rheumatoid arthritis, and multiple sclerosis)
• Performance enhancing drugs (often used by athletes)

4. Idiopathic - the woman may be having hirsutism despite normal hormone levels

Treatments

There are essentially two lines of treatment for hirsutism - one is medical management and the other is a cosmetic treatment.

Medical treatments for hirsutism -

A. Birth control pills - It's possible to reduce the severity and intensity of hair growth using birth control pills- the most commonly prescribed medical intervention! The birth control pills help by decreasing the production of androgens by ovaries. Besides this, estrogen present in the pills also helps the liver to produce more of sex hormone binding protein- these proteins bind to circulating androgens, thereby reducing their action on the body. Both these actions help in reducing the growth of hair on the body.

B. Anti-androgen medications - There are three categories of anti-androgen medications, which are commonly used for the treatment of hirsutism.

• I. Spironolactone - Spironolactone is a diuretic medicine, which blocks the effects of androgens on the hair follicles, thus controlling hair growth.
• II. Finasteride - Finasteride works by blocking the conversion of body testosterone into its more potent chemical entity, thereby limiting the effect of testosterone on hair growth.
• III. Flutamide - Flutamide is a potent anti-androgen, which blocks the actions of androgens and helps in controlling the hair growth.

However, we have to ensure that the woman is not pregnant when taking any of these three medications. These medicines are often combined with oral contraceptives, which also have a synergistic effect in reducing the severity of hirsutism. One should also seek an expert opinion before starting these medications as there can be serious side effects, especially on liver.

C. Steroids - Low dose dexamethasone can be used to control the overactive adrenal glands when used carefully. However, long-term steroid therapy has got its own side effects and this therapy should only be considered under expert care and guidance.

D. Insulin sensitizing medicines - Medicines such as Metformin and Pioglitazone (Basically these are anti-diabetic medications) help in reducing insulin resistance in the body, which, in turn, helps in controlling the effects of excessive circulating androgens.

Cosmetic treatment for hirsutism -

One very important aspect of cosmetic management of hirsutism is self-care. This can include shaving, waxing, use of depilators and bleaching creams. All these measures help to reduce the amount of visible hair in undesired parts of the body. But, this needs to be done very frequently for a sustained visible effect.

Permanent hair removal is also possible using electrolysis or LASER treatment. In electrolysis treatment, electric current is passed into the hair follicle using a needle, which damages the root of the hair permanently. Similarly, LASER treatment uses LASER to destroy the hair follicle. Both these are effective methods to get rid of the undesired hair. However, we do not yet know if there are any long-term complications or side effects of these methods and these methods are not yet approved by the US FDA. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Related Tip: How Safe is Laser Surgery for Facial Hair Removal??

 

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

1. Facial hair growth
2. Excessive pubic and underarm hair
3. An enlarged penis or clitoris
4. Early onset of puberty in girls
5. Development of enlarged breasts in boys

Symptoms of adrenal cancer in adults includes:

1. Excessive weight gain in the abdomen and above the collar bone
2. High blood pressure
3. Irregular menstruation
4. Easy bruising
5. Depression
6. Frequent urge to urinate
7. Muscle cramps

Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person’s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

1. Biopsy of the tumor
2. CT scan
3. MRI scan
4. PET scan
5. Adrenal angiography

Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. However, adrenal cancer can recur and hence it is important to schedule and maintain regular check-ups with your doctor.

There are women who feel their looks are spoilt because of the presence of excessive body hair. While hair on women's body is common, excessive body hair isn't a normal condition and must be taken seriously. Women are generally unaware that the condition is known as Hirsutism.

What is Hirsutism?

Hirsutism can be defined as growth of excessive facial and body hair in women. With the world obsessed with flawless skin, such changes from feminine hair pattern (soft, fine, vellus hair) to masculine hair pattern (hard, dark, terminal hair) in a woman is generally unwelcoming and, hence, very distressing for the woman.

Why do some women develop Hirsutism?

In order to understand the reasons for such excessive growth in some women, it is important to understand the differences in the physiology of men and women. The male or female appearance of one's body is dependent on a delicate balance between male and female sex hormones. There is a predominance of the hormone estrogen in a woman's body, whereas androgens (testosterone) are the predominant sex hormones among men. However, some amount of androgens is secreted by the ovaries and adrenal glands (located next to kidneys) in women also. But, an excessive production of these hormones results in Hirsutism. Hormonal imbalance is by far the most common cause of Hirsutism.

Causes of Hirsutism

The common causes of hirsutism include:

1. Endocrine causes

• Polycystic Ovarian Syndrome (PCOS) - PCOS is a condition of hormonal imbalance in the body, which can result in an irregular menstrual cycle, enlarged ovaries with a cystic appearance on USG, infertility, obesity and hirsutism. For more information on the causes and management of PCOS.
• Cushing's syndrome - Excessive production of hormone Cortisol by the adrenal glands can lead to symptoms such as high blood pressure, abdominal obesity, skin discoloration, muscle weakness, irregular menstruation, and hirsutism etc. This syndrome is known as Cushing's syndrome.
• Congenital Adrenal Hyperplasia (CAH) - CAH is a condition of excessive production of hormones Androgens and Cortisol by the adrenal glands and generally manifests in childhood in the form of virilization. In such cases, CAH can present with symptoms such as ambiguous genitals, obesity, hypertension etc. However, sometimes the manifestation of CAH is deferred to early adulthood and results in milder symptoms, hirsutism being one of them.

2. Tumors - Tumors in ovary or adrenal glands can again cause hirsutism due to excessive production of androgens

3. Medications

• Long term steroid consumption (commonly used for immunosuppression, rheumatoid arthritis, and multiple sclerosis)
• Performance enhancing drugs (often used by athletes)

4. Idiopathic - the woman may be having hirsutism despite normal hormone levels

Treatments

There are essentially two lines of treatment for hirsutism - one is medical management and the other is a cosmetic treatment.

Medical treatments for hirsutism -

A. Birth control pills - It's possible to reduce the severity and intensity of hair growth using birth control pills- the most commonly prescribed medical intervention! The birth control pills help by decreasing the production of androgens by ovaries. Besides this, estrogen present in the pills also helps the liver to produce more of sex hormone binding protein- these proteins bind to circulating androgens, thereby reducing their action on the body. Both these actions help in reducing the growth of hair on the body.

B. Anti-androgen medications - There are three categories of anti-androgen medications, which are commonly used for the treatment of hirsutism.

• I. Spironolactone - Spironolactone is a diuretic medicine, which blocks the effects of androgens on the hair follicles, thus controlling hair growth.
• II. Finasteride - Finasteride works by blocking the conversion of body testosterone into its more potent chemical entity, thereby limiting the effect of testosterone on hair growth.
• III. Flutamide - Flutamide is a potent anti-androgen, which blocks the actions of androgens and helps in controlling the hair growth.

However, we have to ensure that the woman is not pregnant when taking any of these three medications. These medicines are often combined with oral contraceptives, which also have a synergistic effect in reducing the severity of hirsutism. One should also seek an expert opinion before starting these medications as there can be serious side effects, especially on liver.

C. Steroids - Low dose dexamethasone can be used to control the overactive adrenal glands when used carefully. However, long-term steroid therapy has got its own side effects and this therapy should only be considered under expert care and guidance.

D. Insulin sensitizing medicines - Medicines such as Metformin and Pioglitazone (Basically these are anti-diabetic medications) help in reducing insulin resistance in the body, which, in turn, helps in controlling the effects of excessive circulating androgens.

Cosmetic treatment for hirsutism -

One very important aspect of cosmetic management of hirsutism is self-care. This can include shaving, waxing, use of depilators and bleaching creams. All these measures help to reduce the amount of visible hair in undesired parts of the body. But, this needs to be done very frequently for a sustained visible effect.

Permanent hair removal is also possible using electrolysis or LASER treatment. In electrolysis treatment, electric current is passed into the hair follicle using a needle, which damages the root of the hair permanently. Similarly, LASER treatment uses LASER to destroy the hair follicle. Both these are effective methods to get rid of the undesired hair. However, we do not yet know if there are any long-term complications or side effects of these methods and these methods are not yet approved by the US FDA.

Related Tip: How Safe is Laser Surgery for Facial Hair Removal??

In case you have a concern or query regarding gynaecological issues, you can consult a gynaecologist online & get the answers to your questions through online doctor consultation via video call.

 

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

1. Facial hair growth
2. Excessive pubic and underarm hair
3. An enlarged penis or clitoris
4. Early onset of puberty in girls
5. Development of enlarged breasts in boys

Symptoms of adrenal cancer in adults includes:

1. Excessive weight gain in the abdomen and above the collar bone
2. High blood pressure
3. Irregular menstruation
4. Easy bruising
5. Depression
6. Frequent urge to urinate
7. Muscle cramps

Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person’s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

1. Biopsy of the tumor
2. CT scan
3. MRI scan
4. PET scan
5. Adrenal angiography

Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. However, adrenal cancer can recur and hence it is important to schedule and maintain regular check-ups with your doctor.

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

1. Facial hair growth
2. Excessive pubic and underarm hair
3. An enlarged penis or clitoris
4. Early onset of puberty in girls
5. Development of enlarged breasts in boys

Symptoms of adrenal cancer in adults includes:

1. Excessive weight gain in the abdomen and above the collar bone
2. High blood pressure
3. Irregular menstruation
4. Easy bruising
5. Depression
6. Frequent urge to urinate
7. Muscle cramps

Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person’s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

1. Biopsy of the tumor
2. CT scan
3. MRI scan
4. PET scan
5. Adrenal angiography

Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

1. Facial hair growth
2. Excessive pubic and underarm hair
3. An enlarged penis or clitoris
4. Early onset of puberty in girls
5. Development of enlarged breasts in boys

Symptoms of adrenal cancer in adults includes:

1. Excessive weight gain in the abdomen and above the collar bone
2. High blood pressure
3. Irregular menstruation
4. Easy bruising
5. Depression
6. Frequent urge to urinate
7. Muscle cramps

Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person’s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

1. Biopsy of the tumor
2. CT scan
3. MRI scan
4. PET scan
5. Adrenal angiography

Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

It is normal for a woman to have fine and light facial and body hair. The problem arises when the facial hair is thick and are present in excess (more like males), especially in the sideburns, chin, upper and lower lip area. It leaves them highly embarrassed, shattering their self-confidence like never before. While threading or waxing do help, but it is a temporary solution. Sooner or later the problem resurfaces leaving them helpless and distressed. In fact, many, if not all, females have to face bullying, harassment, and humiliation only because they have facial hair. At times, the situation goes to such an extent that the person starts avoiding functions and get-togethers. For such women, laser therapy comes as a blessing aiding in effective facial hair reduction and removal.

What triggers excessive facial hair in females?
Hormonal imbalance (especially, increased level of testosterone or androgen) is one of the prime factors that results in thick and unwanted facial hair in females. This hormonal imbalance and the resulting appearance of facial hair can be brought about by medical conditions such as

1. PCOS (Polycystic Ovarian Syndrome), characterized by the presence of cysts in one or both the ovaries
2. Congenital Adrenal Hyperplasia (an inheritable autosomal recessive disorder which interferes with the ability of the adrenal glands to produce the sex hormones
3. Menopause
4. An ovarian tumor can play an instrumental role in the appearance of excessive facial hair in females
5. Obesity
6. Cushing's Syndrome

Laser Therapy for Facial Hair Reduction
The Laser Therapy can work wonders, reducing the facial hair with elan and without any hassle. In Laser therapy, a high-intensity light beam (laser) is focussed on the target area (in this case, the facial hair). The light is being absorbed by the pigment present in the hair follicles thereby destroying the targeted hair.

Steps involved in the laser-assisted facial hair reduction
Before carrying out the laser hair removal, the facial hair undergoes trimming (usually just a few mm above the surface of the facial skin).

1. For proper penetration of the laser beam and also to keep the epidermal skin layer safeguarded, a cooling gel or a cooling device is used during the procedure. Preventive measures should also be implemented for the safety of the eye.
2. The laser beam is then focussed on the target skin to be treated. It is also important to monitor the treated area closely to ward off any complications that may result from the treatment.
3. Finally, the dermatologist uses ice packs, anti-inflammatory lotions (cold water can also be used) to cool the treated skin area.
4. The time interval between two sessions depends upon the body part that is being treated.

Benefits

1. The effect of laser facial hair removal is more precise and long-lasting.
2. It enhances your overall appearance doing your confidence a world of good.
3. With experienced dermatologists, chances of major complications are almost negligible.

Excess facial hair growth in a woman results from a condition known as the hirsutism. The growth in hair pattern is exactly similar to that of an adult male. Areas, where abnormal hair growth is visible, are chest, above the lips, etc. These hairs are dark, but fine in nature. They are more commonly known as peach fuzz.

There could be a number of reasons for excess facial hair in a woman:

1. Genetic reasons: Women from the Indian sub-continent or Mediterranean region are more likely to have facial hair as compared to their American, European and East-Asian counterparts. One of the common reasons for facial hair growth is genetics. It is a trend that runs in the family, it is more likely that a woman will get it. There is not much that can be done in this case except managing the hair growth effectively.
2. Imbalance of the hormone: Abnormal hormone production can lead to hirsutism. In many cases, there are conditions where female starts producing male hormones leading to abnormal hair growth in the face. One of the most common causes of facial hair growth is polycystic ovarian syndrome (POS). This again is a hormonal imbalance leading to facial hair growth. Even adrenal gland related disorders such as Cushing’s syndrome, Adrenal cancer and congenital adrenal hyperplasia can lead to excess hair.
3. Medications: Certain medication can lead to excess hair growth in the face. For instance, the certain steroid such as anabolic can lead to excess hair growth. Minoxidil is also known to cause hirsutism if taken in excess of 1 ml per day. Other medication related to testosterone and cyclosporine can lead to excess facial hair in females. It is advised to follow the doctor’s advice before consuming any of these medicines.
4. Androgens: Although androgen is a male hormone, it is present in minute quantities in women too. Facial hair increase is nothing, but the sudden increased production of androgen in a female. Even birth control pills can lead to an increased production of androgen in the body. In these cases, it is very important to seek medical advice.

Treatment and remedies:
Medical help:
One should get medical help at the earliest if one of these conditions matches their symptoms:

• The hair growth is sudden and abrupt.
• One witness male features such as increases muscle, acne and reduced breast size.
• Certain medication has led to the hair growth.

Home Remedies:

• Usage of shaving, plucking and depilatory cream
• Laser hair reduction procedure shows immediate results in stopping and countering any further hair growth.
• Electrolysis can be tried to permanently damage the follicles.
• Weight loss is another good solution to excess hair growth.

Hirsutism is a medical condition in women in which they grow unwanted and male-pattern hair on areas of the body such as the face, back, and chest. This condition may develop because of extra male hormones known as androgens, mainly testosterone. It can also be genetic. This excess amount of androgen (virilization process) leads to Hirutism. Signs and symptoms of virilization include acne, voice deepening, and increase in muscle mass, balding, reduced breast size, and clitoris enlargement.

Causes -

There are a number of causes which lead to Hirsutism in women such as a tumor in the adrenal glands and ovaries, PCOS or Polycystic Ovary Syndrome, certain medications for the treatment of endometriosis and depression, Congenital Adrenal Hyperplasia, and Crushing Syndrome. Out of these causes of Hirsutism, PCOS or Polycystic Ovary Syndrome is the most common.

Polycystic Ovary Syndrome, abbreviated as PCOS, is the most common disorder in sex hormones among women in their reproductive age. According to Ayurveda, disturbance in balancing three prominent elements, Kapha, Pitta, and Vata, leads to health and medical issues.

Recommendations -

There are a few changes which women can make in their eating habits and lifestyle for treating PCOS.

• Terminate the consumption of smoking and alcohol.

• Avoid junk food, oily food, and meat.

• Avoid sugar as it increases Kapha, consume honey instead which helps in the reduction of Kapha.

• Avoid using excessive contraceptives.

• Have a balanced diet.

• Exercise regularly but avoid heavy physical activities.

• Maintain suitable body weight.

Take Away -

Hirsutism is a medical condition in females where they grow an unusual amount of hair on face, chest, and back like men. There is a number of causes for Hirsutism but the most common of them all is PCOS or Polycystic Ovary Syndrome. Ayurveda provides medications and treatments for PCOS with some changes in lifestyle and food habits.