A Case of Lean Idiopathic Hirsutism not Having Insulin Resistant Unresponsive to Conventional Treatment for Hirsutism-A Case Report

Hirsutism is the presence of terminal (coarse) hairs in females in a male like pattern, which affects 5-10% of women of the sex steroids androgens are the most important in determining the type and distribution of hairs over the human body. Under the influence of androgens hair follicles that are producing vellus type hairs can be stimulated to begin producing terminal hairs. The activity of local 5 alpha reductase (5 alpha RA) determines to a great extent the production of dihydrotestosterone (DHT) and consequently the effects of androgens on hair follicles. The commonest cause is an ovulation, secondary to PCOS, a fairly common disorder, affecting 6-10% of women of reproductive age group. Besides PCOS other hormonal causes like thyroid hormone deficiency, growth hormone deficiency or hyperprolacinaemia, or hyperinsulinemia or IR may act on their own or synergistically increasing adrenal androgens. A serum T (Testosterone) over 2ng/ml warrants exploring for an androgen secreting tumor. Other causes include non classical adrenal hyperplasia. Occasionally it may not be because of any these causes when it is termed idiopathic hirsutism (IH). Normally these patients of IH respond to 5 alpha reductase inhibitors. Recently high incidence of association of IR has been reported in lean IH. We report a case of lean IH not having IR and very unresponsive to treatment although we are trying to follow her up before undertaking any type of eflornithine cream or laser therapy.