in a patient with
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
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
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
Hirsutism and acne in a patient with polycystic ovary