Hirsutism yog ib yam kab mob uas cuam tshuam rau cov poj niam nkaus xwb, uas tshwm sim los ntawm kev nce hauv cov plaub hau ntawm cov hwj txwv, lub cev ... ib qho ntawm feem ntau kev puas siab puas ntsws loj rau cov poj niam cuam tshuam.

Kev txhais ntawm hirsutism

Qhov no yog exaggerated kev loj hlob ntawm cov plaub hau kev loj hlob nyob rau hauv txiv neej tej thaj chaw (hwj txwv, lub cev, nraub qaum, thiab lwm yam) los ntawm cov hluas los yog dheev nyob rau hauv ib tug poj niam laus.

Hirsutism los yog plaub hau ntau dhau?

Peb paub qhov txawv ntawm hirsutism los ntawm qhov nce ntawm cov plaub hau ib txwm loj hlob (caj npab, ceg, thiab lwm yam) hu ua hypertrichosis. Cov plaub hau los ntawm hypertrichosis yog li tsuas yog cuam tshuam rau thaj chaw ib txwm muaj rau cov poj niam, tab sis cov plaub hau ntev dua, tuab thiab tuab dua li niaj zaus. 

Tsis zoo li hirsutism, qhov hyperpilosity feem ntau twb muaj nyob rau hauv thaum yau thiab cuam tshuam rau ob leeg poj niam txiv neej. Hypertrichosis feem ntau yog tsev neeg thiab nws muaj nyob ib ncig ntawm Mediterranean phiab thiab hauv xim av. Yog li ntawd, kev kho tshuaj hormonal tsis zoo thiab feem ntau muab cov plaub hau tshem tawm.

Hirsutism yog qhov kev xav ntawm kev cuam tshuam ntawm txiv neej cov tshuaj hormones rau poj niam kab mob. Muaj peb yam tseem ceeb ntawm cov tshuaj hormones uas tuaj yeem cuam tshuam cov plaub hau kev loj hlob ntawm cov txiv neej hauv cov poj niam:

Txiv neej cov tshuaj hormones los ntawm zes qe menyuam (testosterone thiab Delta 4 Androstenedione):

Lawv qhov kev nce ntxiv tuaj yeem yog qhov kev xav ntawm cov qog zes qe menyuam zais cov txiv neej cov tshuaj hormones lossis ntau zaus ntawm microcysts ntawm zes qe menyuam zais cov tshuaj hormones (micropolycystic zes qe menyuam syndrome). Nyob rau hauv qhov kev tshwm sim ntawm ib qho kev nce siab nyob rau hauv serum testosterone los yog Delta 4-androstenedione theem, tus kws kho mob tau sau ib qho endovaginal ultrasound los nrhiav ob pathologies (micropolycystic zes qe menyuam los yog zes qe menyuam qog).

Txiv neej cov tshuaj hormones los ntawm cov qog adrenal

Qhov no yog SDHA rau De Hydroepi Androsterone Sulfate secreted los ntawm ib tug qog adrenal thiab ntau zaus nws yog ib tug functional adrenal hyperandrogenism los ntawm nruab nrab nce nyob rau hauv lub secretion ntawm 17 hydroxyprogesterone (17-OHP) ces yuav tsum tau ib tug stimulation xeem nrog Synacthène® kom paub meej tias qhov kev kuaj mob. Tsis tshua muaj, vim tias nws tau kuaj pom zoo thaum yug los ntawm cov qauv ntshav los ntawm pob taws rau hnub thib 3 ntawm lub neej los ntawm kev ntsuas qib ntawm 17 hydroxyprogesterone (17-OHP) hauv cov ntshav, qhov anomaly tuaj yeem tshwm sim: nws yog kev ua ntawm congenital. adrenal hyperplasia los ntawm 21-hydroxylase deficiency txuas rau kev hloov pauv ntawm nws cov noob ntawm chromosome 6.

Cortisol

Kev nce hauv cortisol hauv cov ntshav (Cushing's syndrome) tuaj yeem yog vim kev siv ntev ntawm corticosteroids, qog qog adrenal secreting cortisol, lossis qog qog secreting ACTH (ib yam tshuaj hormones secretes cortisol los ntawm lub qog adrenal).

Cov qog ua rau feem ntau tshwm sim tam sim hauv ib tus poj niam laus, thaum lub hirsutism tam sim no thaum hluas yog feem ntau vim yog kev ua haujlwm ntawm zes qe menyuam lossis adrenal hyperandrogenism.

Nrog rau cov tshuaj hormonal ib txwm thiab ib txwm ua ntawm zes qe menyuam ultrasound, nws yog hu ua idiopathic hirsutism.

Nyob rau hauv kev xyaum, yog li ntawd, nyob rau hauv lub xub ntiag ntawm hirsutism, tus kws kho mob nug rau ib tug ntshav ntau npaum ntawm testosterone, Delta 4-androstenedione, SDHA thiab 17-hydroxyprogesterone (nrog Synacthène® kuaj yog tias nws yog nruab nrab), cortisoluria nyob rau hauv cov kev tshwm sim ntawm xav tias Cushing. thiab ultrasound ntawm zes qe menyuam.

Cov koob tshuaj yuav tsum tau thov yam tsis tau noj cortisone, tsis muaj tshuaj tiv thaiv hormonal rau peb lub hlis. Lawv yuav tsum tau ua thaum sawv ntxov nyob ib ncig ntawm 8 teev sawv ntxov thiab nyob rau ib qho ntawm thawj rau hnub ntawm lub voj voog (lawv yuav tsum tsis txhob thov thaum thawj peb xyoos ntawm cov tub ntxhais hluas vim lawv tsis cuam tshuam).

Cov plaub hau tawv ntawm lub ntsej muag, thorax, nraub qaum ... hauv cov poj niam.

Tus kws kho mob saib rau lwm cov cim qhia txuas rau hyperandrogenism (nce hauv cov txiv neej cov tshuaj hormones): hyperseborrhea, pob txuv, androgenetic alopecia los yog baldness, menstruation disorders… los yog virilization (clitoral hypertrophy, sib sib zog nqus thiab hoarse suab). Cov cim qhia no qhia txog kev nce qib ntawm cov tshuaj hormones hauv cov ntshav thiab yog li tsis sib cav hauv kev pom zoo ntawm idiopathic hirsutism.

Qhov tshwm sim tam sim ntawd ntawm cov cim qhia tau taw qhia rau cov qog nqaij hlav thaum lawv maj mam txhim kho los ntawm cov hluas yog qhov zoo dua ntawm kev ua haujlwm ntawm zes qe menyuam lossis adrenal hyperandrogenism, lossis txawm tias idiopathic hirsutism yog qhov kev kuaj mob ib txwm muaj.

Risk yam tseem ceeb

Cov yam tseem ceeb rau hirsutism hauv cov poj niam muaj xws li:

• noj cortisone ntau lub hlis (Cushing's syndrome)
• Kev rog: nws tuaj yeem cuam tshuam txog teeb meem cortisol lossis yog ib feem ntawm polycystic zes qe menyuam syndrome. Tab sis peb kuj paub tias rog muaj ib tug nyiam txhawb cov metabolization ntawm txiv neej cov tshuaj hormones.
• tsev neeg keeb kwm ntawm hirsutism

Evolution thiab teeb meem ua tau

Hirsutism txuas rau cov qog ua rau tib neeg muaj kev pheej hmoo txuas rau cov qog nws tus kheej, tshwj xeeb tshaj yog tias nws yog malignant (kev pheej hmoo ntawm metastases, thiab lwm yam).

Hirsutism, txawm tias qog los yog ua haujlwm, ntxiv rau nws txoj kev zoo nkauj tsis yooj yim, feem ntau nyuaj los ntawm pob txuv, folliculitis, baldness hauv cov poj niam ...

Kev kho mob ntawm hirsutism yog raws li kev kho mob ntawm qhov ua rau thiab kev sib xyaw ua ke ntawm kev noj tshuaj tiv thaiv androgens thiab tshem tawm cov plaub hau lossis depilation cov txheej txheem.

Kev kho qhov ua rau

Kev tshem tawm ntawm zes qe menyuam lossis qog adrenal, ACTH-secreting qog (feem ntau nyob hauv lub ntsws)… yog tias tsim nyog.

Kev sib xyaw ntawm cov txheej txheem depilation lossis depilation thiab cov tshuaj tiv thaiv androgen

Kev tshem tawm cov plaub hau los yog depilation cov tswv yim yuav tsum tau ua ke nrog cov tshuaj tiv thaiv androgen hormonal kom txwv txoj kev pheej hmoo ntawm coarse plaub hau regrowth

Cov plaub hau tshem tawm thiab depilation

Ntau cov tswv yim siv tau xws li tshuaj dawb cov plaub hau, shaving, depilatory cream, waxing los yog txawm hluav taws xob tshem tawm cov plaub hau nyob rau hauv lub dermatologist lub chaw ua hauj lwm uas yog mob thiab tedious.

Muaj ib lub qab zib raws li eflornithine, ib qho tshuaj tiv thaiv kab mob molecule uas, siv hauv zos, inhibits ornithine decarboxylase, ib qho enzyme koom nrog hauv kev tsim cov plaub hau los ntawm cov hauv paus plaub hau. Qhov no yog Vaniqa® uas, siv ob zaug ib hnub, txo cov plaub hau kev loj hlob.

Laser tshem tawm cov plaub hau yog qhia nyob rau hauv rooj plaub uas nws kim heev hirsutism. Nws yog ua ke nrog anti-androgen therapy los tiv thaiv kev rov tshwm sim.

Anti androgens

Lub sij hawm anti-androgen txhais tau hais tias cov molecule inhibits kev khi ntawm testosterone (kom meej meej 5-dihydrotestosterone) rau nws cov receptor. Raws li testosterone tsis muaj kev nkag mus rau nws cov receptors hauv cov plaub hau, nws tsis tuaj yeem muaj cov nyhuv stimulating.

Muaj ob txoj hauv kev siv tam sim no:

• cyproterone acetate (Androcur®) tau them rov qab hauv Fabkis rau qhov qhia txog hirsutism. Ntxiv rau nws cov anti-androgen receptor blocking kev ua si, nws kuj muaj cov nyhuv antigonadotropic (nws txo qhov tsim ntawm androgens los ntawm kev txo cov pituitary stimulation) thiab inhibition ntawm 5-dihydrotestosterone / receptor complex ntawm theem ntawm androgen binding protein. .

Nws yog ib qho progestogen uas yuav tsum yog li ntawd feem ntau yuav tsum tau ua ke nrog cov tshuaj estrogen kom ua raws li lub ntuj hormonal voj voog ntawm cov poj niam: tus kws kho mob feem ntau sau ib ntsiav tshuaj ntawm Androcur® 50 mg / hnub ua ke nrog cov tshuaj estrogen ntuj hauv ntsiav tshuaj, gel lossis thaj, nees nkaum hnub. tawm ntawm nees nkaum yim.

Kev txhim kho hauv hirsutism tsuas yog pom tom qab li 6 lub hlis ntawm kev kho mob.

• spironolactone (Aldactone®), cov tshuaj diuretic, tuaj yeem muab tawm ntawm daim ntawv lo. Dhau li ntawm nws cov anti-androgenic receptor thaiv cov nyhuv, nws inhibits testosterone synthesis. Tus kws kho mob tau sau ob ntsiav tshuaj ib hnub ntawm 50 lossis 75 mg kom ua tiav cov koob tshuaj txhua hnub ntawm 100 mus rau 150 mg / hnub, ua ke, kaum tsib hnub hauv ib hlis, nrog rau cov tshuaj uas tsis yog androgenic progestogen kom tsis txhob muaj kab mob hauv lub voj voog. Raws li nrog cyproterone acetate, cov nyhuv pib pom tsuas yog tom qab 6 lub hlis ntawm kev kho mob, qee zaum ib xyoos.