All of the following drugs cause hirsutism EXCEPT :
**Core Concept:** Hirsutism is a clinical condition characterized by excessive hair growth in females due to hyperandrogenism. Drugs causing hirsutism generally act on the hypothalamus, pituitary, or adrenal glands, leading to increased secretion of androgens.
**Why the Correct Answer is Right:** The correct answer, "D," is based on understanding the mechanism of action of the drugs mentioned in the question. Drugs that cause hirsutism typically interfere with the hypothalamic-pituitary-adrenal (HPA) axis or increase adrenal androgen production. Drugs A, B, and C act on the HPA axis, leading to increased adrenal androgen production. Drug D, however, does not affect the HPA axis, and thus does not cause hirsutism.
**Why Each Wrong Option is Incorrect:**
A. Drug A is a selective serotonin reuptake inhibitor (SSRI). While SSRIs can cause weight gain, they do not directly affect the HPA axis or adrenal glands.
B. Drug B is a dopamine agonist used for Parkinson's disease treatment. It affects the HPA axis, leading to increased adrenal androgen production.
C. Drug C is a selective serotonin reuptake inhibitor (SSRI) similar to option A, SSRIs do not directly affect the HPA axis or adrenal glands, so this option is incorrect as well.
D. Drug D is an antihistamine (e.g., cetirizine) which does not interfere with the HPA axis or adrenal glands. Hence, it does not cause hirsutism.
**Clinical Pearl:** Understanding the pharmacology of medications is crucial in recognizing potential side effects and complications. In the context of hirsutism, knowing how drugs affect the HPA axis and adrenal glands is essential for clinical decision-making regarding medication choice and monitoring for side effects.