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Hirsutism 75 Figure 9.11 Acanthosis nigricans in a patient with PCOS. back, lower back, upper arm, inner thigh. According with this scale each area has a score ranging from 0 to 4 depending on the presence, thickness and confluence of hair. A diagnosis of hirsutism can be made when the total score is higher than 8/36. A score higher than 15 Figure 9.9 is usually associated with other signs of hyperandro- Hirsutism in a patient with polycystic ovary syndrome. genism. The most common cause of hirsutism is polycystic ovarian syndrome (PCOS) (Figures 9.9–9.11, Table 9.2). Other causes are quite rare (Table 9.3). A diagnosis of idiopathic hirsutism requires demonstration of normal ovulatory cycles and normal androgenic levels (Table 9.4). Table 9.5 shows laboratory work-up useful to evalu- ate the presence of hirsutism. Table 9.2 PCOS: diagnostic criteria – presence of at least two elements Oligo-anovulation Hyperandrogenism (clinical and/or biochemical) Micropolycystic ovaries (12 or more 2–9 mm follicles in each ovary and/or ovarian volume >10 ml) Exclusion of specific etiologies Figure 9.10 Hirsutism and acne in a patient with polycystic ovary syndrome.
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