DIFFERENTIATING NON-CLASSIC ADRENAL HYPERPLASIA AND POLYCYSTIC OVARIAN SYNDROME PRESENTING WITH HIRSUTISM: A REVIEW

Karra Geetha*, Kandi Sandhya Devi, Madhavaneni Shishla, Atchula Sri Priya and T. Rama Rao

ABSTRACT

Hirsutism, characterized by excessive terminal hair growth in a male-like distribution in females, affects 5–10% of women and often indicates underlying hyperandrogenism. Common causes include polycystic ovary syndrome (PCOS), non-classical congenital adrenal hyperplasia (NCAH), androgen-producing tumors, Cushing's syndrome, and certain medications. While PCOS is the most frequent etiology, NCAH, typically caused by a 21-hydroxylase deficiency, also plays a significant role. The clinical presentation varies but often includes increased terminal hair growth on the face, upper body, and abdomen. The Ferriman-Gallwey score aids in assessing severity. Diagnosis involves evaluating serum markers such as testosterone, DHEAS, 17-hydroxyprogesterone, and others, with ACTH stimulation tests and imaging for confirmation. Management strategies are etiology-specific. PCOS treatment focuses on suppressing androgen production using combined oral contraceptives (COCs) and anti-androgens like spironolactone or finasteride. Insulin sensitizers may benefit metabolic disturbances. For NCAH, glucocorticoid therapy regulates cortisol levels, reducing ACTH-driven androgen excess, and may be combined with anti-androgens or oral contraceptives. Hair removal techniques such as laser therapy or eflornithine cream address cosmetic concerns. Differentiating between PCOS and NCAH is critical for tailored treatment, minimizing mismanagement, and addressing both endocrine dysfunction and associated symptoms. A comprehensive approach improves clinical outcomes and enhances quality of life for affected individuals.

Keywords: Hirsutism, Non-classic adrenal hyperplasia, Polycystic ovarian syndrome, Hyperandrogenism, 21-hydroxylase, Hyperinsulinemia.