HIRSUTISM

Ask the Following Questions:

1. Is there clitoral enlargement or other signs of virilism? These findings would suggest an ovarian tumor, an adrenal tumor or hyperplasia, chromosome mosaicism, and true hermaphroditism, which is rare.
2. Is there obesity? The presence of obesity and hirsutism should bring to mind Cushing's syndrome. However, it is also a sign of polycystic ovaries.
3. Is there a history of the use of the steroids or other drugs? Adrenocortical steroids, testosterone, phenytoin, minoxidil, and diazoxide are just a few of the drugs that may cause hirsutism.
4. Is there an ovarian mass? The presence of an ovarian mass should make one think of polycystic ovaries, an arrhenoblastoma, or granulosis cell tumor. Remember, there may be no ovarian mass in polycystic ovary syndrome (Stein-Leventhal syndrome).

DIAGNOSTIC WORKUP

The routine diagnostic workup includes a serum free testosterone, free cortisol, prolactin, a skull x-ray (much more economical than a CT scan or MRI of the brain), and a urinary gonadotrophin assay. If a pituitary tumor or lesion is strongly suspected, an FSH and LH should be done regardless of results of routine tests. An overnight dexamethasone test is more accurate than a routine free cortisol in diagnosing Cushing's syndrome. Pelvic ultrasound and CT scan of the abdomen would complete the workup, but why order these expensive diagnostic tests before consulting a gynecologist or endocrinologist?

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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