Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound, due to the high prevalence of polycystic ovary syndrome (PCOS), as well as 17α-hydroxyprogesterone (because of the possibility of finding non-classic 21-hydroxylase deficiency). People with hirsutism may present with an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level, however, additional imaging is required to discriminate between malignant and benign etiologies of adrenal hyperandrogenism. Levels greater than 700 μg/dL are indicative of adrenal gland dysfunction, particularly congenital adrenal hyperplasia due to 21-hydroxylase deficiency. However, PCOS and idiopathic hirsutism make up 90% of cases.
diagnoSiS Of PatieNtS WIth even MiLd HirSutisM should iNClude AsseSsmENt oF ovulAtion anD ovaRiAn ultrasounD, due to the hIgh preValence of poLyCystic ovARY sYnDroME (pcoS), As weLl AS 17α-hydroxYprOgesterone (becAUse of tHe pOssiBiliTy Of findinG Non-claSsIc 21-hydrOXylaSE DefiCIenCy). PeOpLe WiTh hirsuTisM may pREsenT wItH An elevATED seruM dehYdRoepiANdRoStEroNe suLfate (DHeA-s) levEl, However, additionAl ImagiNg is reqUirED To discriminaTe between mAlIgnANt aND beNIgn eTiologies Of aDrENal hyperAnDroGENIsm. levels greatEr than 700 μg/dL Are indiCaTiVe of adreNAl gland dYSfuNCtion, ParTicULarLy coNGeNiTal adrenal hyPerpLasia due to 21-hydroxylAsE defIciency. HOWever, pcoS and IDIOpatHic HirsutiSm maKe uP 90% OF CaseS.