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The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. In patients whose hirsutism is not related to medication use, evaluation is focused on testing for endocrinopathies and neoplasms, such as polycystic ovary syndrome, adrenal hyperplasia, thyroid dysfunction, Cushing syndrome, and androgen-secreting tumors.

Symptoms and findings suggestive of neoplasm include rapid onset of symptoms, signs of virilization, and a palpable abdominal or pelvic mass.

A total testosterone level greater than 200 ng per d L (6.94 nmol per L) should prompt evaluation for an androgen-secreting tumor.

Further workup is guided by history and physical examination, and may include thyroid function tests, prolactin level, 17-hydroxyprogesterone level, and corticotropin stimulation test.

DAVID BODE, CPT, MC, USA, Brooke Army Medical Center, Fort Sam Houston, Texas DEAN A.

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