Table 1

Causes of hirsutism

CauseClues to diagnosis
Androgenic hirsutism
Polycystic ovary syndrome (PCOS)

  • Usually accompanied by menstrual irregularities.

Non-classical congenital adrenal hyperplasia

  • Clinically indistinguishable from PCOS.

  • Elevated 17-hydroxyprogesterone levels.

Cushing syndrome

  • Other clinical signs of Cushing are apparent.

Androgen-secreting ovarian tumour (eg, Sertoli-Leydig cell tumour)

  • Rapid progression.

  • Other virilising symptoms (acne, deepening of voice, increased libido).

Androgen-secreting adrenal tumour (eg, adrenocortical carcinoma)

  • Cosecretion of cortisol and androgens is highly suggestive.

Non-androgenic hirsutism
Idiopathic

  • Diagnosis of exclusion.

  • Normal serum androgens levels.

Familial

  • Positive family history.

  • Normal serum androgens levels.

Drug-induced

  • Testosterone, danazol, progestins, anabolic steroids, valproic acid, methyldopa