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Assessment, diagnosis and treatment of a patient with hirsutism


Background A 20-year-old woman presented with excess facial and body hair, which she had noticed for the first time after her menarche and which had gradually worsened since then. In addition, the patient's menstrual cycles had always been irregular. Her family history revealed that her mother also had a history of excess body hair. Among the patient's family members there was no other history of chronic diseases, including type 2 diabetes. She denied taking any regular medications and had been shaving and waxing regularly to remove the excess hair. On examination, the patient was a lean woman with normal vital signs. Prominent coarse hair was noted over her upper lip, chin, lower abdomen, lower back and upper legs. The remainder of the physical examination was unremarkable.

Investigations Physical examination, and investigations that included a transabdominal pelvic ultrasound scan and measurement of TSH, prolactin, 17-hydroxyprogesterone and total testosterone levels.

Diagnosis Hirsutism associated with polycystic ovary syndrome.

Management The patient was treated with cyproterone acetate 2 mg/day and ethinylestradiol 0.035 mg/day in combination with spironolactone 100 mg/day as well as with laser hair removal. The patient's symptoms had improved considerably after 1 year of treatment. A cardiometabolic risk assessment, including a standard oral glucose tolerance test and a lipid profile before and after treatment, revealed normal fasting and 2 h plasma glucose levels both at baseline and after 12 months, and a low-normal HDL-cholesterol level that returned to normal after 12 months.

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Figure 1: Photographs of the case patient's lower abdomen and lower back.
Figure 2: The modified Ferriman–Gallwey scoring system for hirsutism.


  1. Sonino N et al. (1993) Quality of life of hirsute women. Postgrad Med J 69: 186–189

    Google Scholar 

  2. Yildiz BO (2006) Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 20: 167–176

    Google Scholar 

  3. Azziz R et al. (2004) Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 89: 453–462

    Google Scholar 

  4. Rittmaster RS (1997) Hirsutism. Lancet 349: 191–195

    Google Scholar 

  5. Ewing JA et al. (1978) Hirsutism, race and testosterone levels: comparison of East Asians and Euroamericans. Hum Biol 50: 209–215

    Google Scholar 

  6. Hatch R et al. (1981) Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 140: 815–830

    Google Scholar 

  7. Yildiz BO (2007) Hormonal and biochemical evaluation of polycystic ovary syndrome. In Contemporary Endocrinology: Insulin Resistance and Polycystic Ovarian Syndrome: Pathogenesis, Evaluation, and Treatment, 241–248 (Eds Nestler JE et al.) Totowa, NJ: Humana Press

    Google Scholar 

  8. Rosner W et al. (2007) Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab 92: 405–413

    Google Scholar 

  9. Legro RS et al. (2006) The Pregnancy in Polycystic Ovary Syndrome study: baseline characteristics of the randomized cohort including racial effects. Fertil Steril 86: 914–933

    Google Scholar 

  10. Zawadzki JK et al. (1992) Diagnostic criteria for polycystic ovary syndrome. In Polycystic ovary syndrome, 377–384 ( Eds Dunaif A et al.) Boston, MA: Blackwell Scientific Publications

    Google Scholar 

  11. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81: 19–25

  12. Azziz R et al. (2006) Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 91: 4237–4245

    Google Scholar 

  13. Yildiz BO (2004) Recent advances in the treatment of polycystic ovary syndrome. Expert Opin Investig Drugs 13: 1295–1305

    Google Scholar 

  14. Carmina E (2002) Anti-androgens for the treatment of hirsutism. Expert Opin Investig Drugs 11: 357–363

    Google Scholar 

  15. Costello MF et al. (2007) Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. Hum Reprod 22: 1200–1209

    Google Scholar 

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Supplementary information

Supplementary information Box 1

Rare disorders in the differential diagnosis of hirsutism. (DOC 34 kb)

Supplementary information Box 3

Initial investigations for a patient with hirsutism. (DOC 34 kb)

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Yildiz, B. Assessment, diagnosis and treatment of a patient with hirsutism. Nat Rev Endocrinol 4, 294–300 (2008).

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