Hirsutism in Children: A Comprehensive Review of Etiology, Clinical Evaluation and Contemporary Management

Hirsutism in children is an uncommon yet clinically significant manifestation characterised by excessive terminal hair growth in androgen-dependent areas. Unlike adults, paediatric hirsutism frequently indicates an underlying endocrine, metabolic, genetic, or neoplastic disorder and therefore requires systematic evaluation. Recent advances have improved understanding of androgen biosynthesis, peripheral androgen sensitivity, and the complex interaction between insulin resistance and hyperandrogenism. Conditions such as premature adrenarche, non-classical congenital adrenal hyperplasia, adolescent polycystic ovary syndrome, and androgen-secreting tumours represent key etiologies. Early identification is crucial to prevent long-term metabolic, reproductive, and psychosocial complications. This review integrates current evidence on pathophysiology, evolving diagnostic strategies, updated laboratory markers, imaging modalities, and contemporary management approaches, offering a practical framework for clinicians managing hirsutism in children.