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CONSTITUTIONAL HIRSUTISM

Constitutional hirsutism refers to SAHA syndromes (Seborrhoea, Alopecia, Hirsutism, Acne).

OVARIAN SAHA: it consists of mild lateral facial and mammary hirsutism, female pattern androgenetic alopecia, seborrhoea and nodulocystic acne, short periods, short and painless cycles and a tendency towards obesity.
There are also somewhat lower levels of SHBG and slightly elevated or normal testosterone levels, although the levels of both are mildly elevated which in turn increase 5-alpha- reductase activity.

SUPRARENAL SAHA OR ADRENARCHY PERSITENCE SYNDROME: in this condition hirsutism tends to be more central than lateral, covering areas such as neck, cleavage and abdomen. It is characterized by long and painful periods with long cycles. It is seen in anxious patients.
 DHEAS and A are slightly elevated. On occasions testosterone is also elevated.
 SBG and 17 OH levels of progesterone are normal.
 If the condition is very severe, determination of plasma cortisol levels should be ordered.

HYPERPROLACTINEMIC SAHA: lateral and medial facial hirsutism, oligoamenorrhea.
 Unexplained mildly elevated prolactine levels.