APPROACH TO PATIENTS WITH HIRSUTISM

Hirsutism is a common medical condition that in most women is due to t he polycystic ovary syndrome or is idiopathic. For a few women, hirsut ism signals a serious underlying disorder such its an ovarian or adren al tumor, congenital adrenal hyperplasia, or Gushing's syndrome. A det ailed medical history and examination can identify women in whom a ser ious disease is suspected and for whom laboratory evaluation is warran ted. Measurements of serum testosterone, dehydroepiandrosterone, and 1 7 alpha-hydroxyprogesterone levels, and 24-hour urinary cortisol conce ntrations are important screening tests. Therapy is directed at suppre ssing ovarian or adrenal androgen production, inhibiting the conversio n of testosterone to dihydrotestosterone, or antagonizing the effects of androgens at the receptor level.