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 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 I 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.