CASE 45: EXCESS HAIR GROWTH
History
A 22-year-old woman is referred to a dermatologist complaining of increasing growth of
hair affecting her face. This has progressed over at least 2 years so that now she needs to
shave to remove her facial hair. She has also noticed facial acne and that her skin is more
greasy. Her periods have become very irregular with her last period being 3 months pre-
viously. Her menarche was at age 13 years, but over the past 3 years her periods have been
very erratic with her intermenstrual interval ranging from a few days to many months and
her blood loss varying from light to heavy. She has had no significant medical illnesses
previously. She is taking no regular medication. She lives alone, smokes 20 cigarettes per
week and drinks about 20 units of alcohol per week. She is a student but has stopped
attending her course because she is embarassed by her appearance.
Examination
She is overweight at 16 stone. Her facial skin is greasy and she has excessive facial hair.
Blood pressure is 132/82 mmHg, pulse 76/min. Physical examination is otherwise normal.
NormalFollicle-stimulating hormone (FSH) 1 U/L 2–8 U/L
Luteinizing hormone (LH) 32 U/L 6–13 U/L
Oestradiol 284 nmol/24 h 10–55 nmol/L
Testosterone 9.6 nmol/L 1–2.1 nmol/LINVESTIGATIONS
Questions
- What is the diagnosis?
- How would you investigate and manage this patient?