Endocrine pattern body hair loss

Specialty: Endocrine and metabolic.

• decrease in sexually distributed hair
• loss of axillary and pubic hair
• endocrine corporal alopecia

Why it occurs

• Primary adrenal insufficiency or Addison's disease (autoimmune or infectious destruction of the adrenal cortex decreases the production of adrenal androgens such as DHEA, essential for the maintenance of pubic and axillary hair in women)
• Panhypopituitarism or Sheehan syndrome (ischemic necrosis of the pituitary gland in the postpartum with loss of gonadotropin and ACTH secretion)
• Male primary hypogonadism due to testicular insufficiency or Klinefelter syndrome (loss of testicular testosterone production)
• Liver cirrhosis (liver failure alters the clearance of estrogens and the synthesis of transport proteins, causing feminization of male body hair)

Initial workup

Basal plasma cortisol at 8:00 AM; basal plasma ACTH; dynamic rapid stimulation test with cosyntropin (synthetic ACTH, measuring cortisol at 30 and 60 minutes); serum total and free testosterone; gonadotropins LH and FSH; serum prolactin; estradiol; and high-resolution brain MRI directed at the pituitary gland and sella turcica.

Standard management

• Hydrocortisone — oral glucocorticoid administered in divided doses of 15-25 mg per day to simulate the physiological diurnal secretion of the adrenal cortex
• Fludrocortisone — synthetic mineralocorticoid to restore blood volume in primary adrenal insufficiency
• Dehydroepiandrosterone — Oral DHEA, optional at doses of 25-50 mg daily in women with adrenal insufficiency to restore libido, secondary sexual hair, and improve mood
• Testosterone undecanate — androgen for intramuscular administration every 10-14 weeks in men with primary or secondary hypogonadism to restore masculine characteristics