Hirsutism Figure Figure Figure

					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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