Let's go on to another case.
Here we have a 34 year old woman who is seen for
recent hirsutism of the face, chest and abdomen.
Hair growth has progressed
over the last few years.
Menstrual cycles have become
irregular over the same time course.
Medical history is otherwise unremarkable
and she doesn't take any medications.
On physical exam, her blood pressure is 138/90
and the remainder of the vital signs are normal.
Her BMI is 26.
On exam, she has acne, dark terminal hairs
appear on the face, chest and abdomen.
The patient's hair is thinning
on the top of her head.
The remainder of the physical
exam is noncontributory.
On lab evaluation, her estradiol
level is 68 picograms per ml,
her FSH is 12 mU/ml
and her beta HCG is negative.
She has a normal prolactin level
and a testosterone level of
120 ng/dL, with a normal TSH.
What is the best
diagnosis for this case?
So looking at the patient's history, she has
hirsutism, altered menses, increased blood pressure,
slightly elevated body mass index
and an elevated testosterone.
These all suggest hyperandrogenism or abnormal
masculine characteristics that develop in a female.
The best diagnosis is
polycystic ovary syndrome,
this is the most common cause in most
women who present with hirsutism.
Women with chronic hirsutism and
menstrual cycles every 25 to 35 days
mostly have idiopathic hirsutism
or polycystic ovarian syndrome.
This accounts for 95% of cases.