家庭醫業 前言及定義 病態生理學 F e r r i m a n - G a l l w e y hirsutism scoring system 9 04 Ferriman-Gallwey score8 (hirsutism) hypertrichosis hypertrichosis hirsutism androgen t e s t o s t e r o n e d i h y d r o t e s t e r o n e a n d r o g e n receptorandrogen (Idiopathic hirsutism) Danazol 臨床評估 林口長庚醫院家庭醫學科 hirsutism, androgen, testosterone 272 家庭醫學與基層醫療 第七期
Ferriman-Gallwey 資料來源 : 參考資料 1 1. 2. ) 3. 4. testosterone 150 ng/dl (5.2 nmol/ L) free testosterone2 ng/dl (0.07 nmol/l) DHEA-S700 mcg/dl (13.6 µmol/l) Ferriman-Gallwey score Endocrine Society Clinical Practice Guidelines t o t a l 家庭醫學與基層醫療 第七期 273
testosterone and DHEA-S 相關病症 1. Polycystic ovary syndrome ( ) 2. i d i o p a t h i c hirsutism 3. 毛症 藥物 用 毛 (8-15 分 ) 中度 毛 ( 15 分 ) 可能性 性 可能性 內分 用藥物 性 程 部或 期 不孕 男性 或 症 性腎上 症 高 激素 1. 口服避孕藥 2. 外用藥物 測 Testosterone 正 高 據 或 Idiopathic hirsutism 無 1. 2. 性 及治療 有 治療 資料來源 : 參考資料 1 274 家庭醫學與基層醫療 第七期
4. Sertoli-Leydig cell tumor testosterone 150 to 200 ng/ dl (5.2 to 6.9 nmol/l) 5. cortisol 6. DHEA-S 7. Hyperthecosis thecal cells 治療 2008 Endocrine society clinical practice guideline 口服避孕藥 1. Luteinizing h o r m o n e,l H (Sex hormone-binding globulin, SHBG) free-androgen 2. Ferriman-Gallwey hirsutism score 8 (95% CI,-11.0 to-4.5) 抗男性激素藥物 1. Spironolactone: aldosterone antagonist 5-alpha-reductase Ferriman-Gallwey h i r s u t i s m s c o r e 4.8 (C I,-7.4 to-2.2) 2. Cyproterone acetate (CPA): spironolactone 5-alpha-reductase 家庭醫學與基層醫療 第七期 275
3. Drospirenone CPA 4. Finasteride: 5-alpha-reductase inhibitor F e r r i m a n - G a l l w e y hirsutism score 30 60% () f i n a s t e r i d e 5 m g spironolactone 100mg spironolactone finasteride 5. Flutamide: finasteride CPA 6. spironolactone finasteride 1. systemic meta-analysis (spironolactone, finasteride, flutamide) Ferriman-Gallwey hirsutism score 4 2. 3. Ferriman-Gallwey hirsutism score 1.7 降低胰島素抗性藥物 1. ( theca cell ) Metformin Thiazolidinediones 2. Ferriman-Gallwey hirsutism score 1.5 (95% CI, -2.8 to -0.2) 3. 類固醇治療 CYP21A2 藥物治療小結 1. 2. antiandrogen 276 家庭醫學與基層醫療 第七期
antiandrogen 3. antiandrogen 4. ()antiandrogen 5. 6. CYP21A2 7. 暫時性除毛 ( ) thioglycolates (hydrogen peroxide)( ) 永久性除毛 1. (Electrolysis) 2. (Photoepilation) 1 74% 35% 外用藥物 Eflornithine (Vaniqa) (ornithine decarboxylase) 非藥物治療小結 1. ( ) 家庭醫學與基層醫療 第七期 277
2. eflornithine 3. 結論 參考資料 1. Martin KA, Chang RJ, Ehrmann DA, et al.: Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008; 93: 1105-20. 2. Ferriman D, Gallwey JD: Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961; 21: 1440 7. 3. Saeed R, Akram J, Changezi HU, Saeed M: Treatment of hirsutism in polycystic ovarian syndrome with Diane, 50 mcg ethinyl estradiol and 2 mg cyproterone acetate. Specialist. 1993; 9: 109 12. 4. S w i g l o B A, C o s m a M, F l y n n D N, e t a l.: Antiandrogens for the treatment of hirsutism: a systematic review and meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2008; 93:1153 60. 5. Wo l f J r J E, S h a n d e r D, H u b e r F, e t a l.: Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair. Int J Dermatol. 2007; 46: 94 8. 6. Polderman MC, Pavel S, le Cessie S, Grevelink JM, van Leeuwen RL: Efficacy, tolerability, and safety of a long-pulsed ruby laser system in the removal of unwanted hair. Dermatol Surg. 2000; 26: 240-3. 7. G o rg u M, A s l a n G, A k o z T, E r d o g a n B: Comparison of alexandrite laser and electrolysis for hair removal. Dermatol Surg. 2000; 26: 37 41. 278 家庭醫學與基層醫療 第七期