What is the best approach to the evaluation of hirsutism?
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The evaluation of hirsutism should begin with a history and physical examination to identify signs and symptoms suggestive of diseases such as polycystic ovarian syndrome (PCOS), hypothyroidism, hyperprolactinemia, hyperandrogenic insulin-resistant acanthosis nigricans (HAIR-AN) syndrome, androgenic tumors, Cushing's syndrome, or congenital adrenal hyperplasia (CAH). Findings suggestive of these diseases include rapid or early-onset hirsutism, menstrual irregularities, hypertension, severe hirsutism, virilization, or pelvic masses (strength of recommendation [SOR]: B, based on a cohort study in a referral population). Hirsutism with unremarkable history and physical exam findings should be evaluated with a serum total testosterone and dehydroepiandrosterone sulfate (DHEAS) level (SOR: B, based on a cohort study in a referral population).
Journal of Family Practice, 54(5) 2005: 465-467.