Question

A 22-year-old G0 presents with hirsutism which has been present since menarche. She states that she has laser treatments done to remove the hair on her chin every couple of months, and was wondering if there are additional treatments which might help her. She is otherwise in good health. She has normal menstrual cycles every 28 days. She is sexually active and uses birth control pills for contraception. The patient is adopted and has no information about family history. She is 5 feet 4 inches tall and weighs 125 pounds. On examination, the patient was noted to have terminal hair growth on her chest. Her TSH, Prolactin, total testosterone, DHEAS, 17-Hydorxyprogesterone levels are normal. Which of the following is the most likely underlying etiology for the hirsutism in this patient?

A. Polycystic ovarian syndrome
B. Side effects of the oral contraceptives
C. Cushing's syndrome
D. Adrenal tumor
E. Idiopathic hirsutism

Answer 1

This patient most likely has Idiopathic hirsutism, as common conditions like PCOS, Cushing's syndrome, and adrenal tumors are ruled out by her normal hormonal levels and regular menstrual cycles.

Step-by-step explanation:

The most likely underlying etiology for the hirsutism in this patient is E. Idiopathic hirsutism. This diagnosis is made because other common causes such as Polycystic ovarian syndrome (PCOS), Cushing's syndrome, and an adrenal tumor have been largely ruled out due to normal hormonal levels and regular menstrual cycles, which are unusual for these conditions. In PCOS, for example, patients often present with irregular menstrual periods, weight gain, and elevated androgen levels, none of which are observed with this patient. Since her TSH, prolactin, total testosterone, DHEAS, and 17-Hydroxyprogesterone levels are normal and she has no other signs or symptoms commonly associated with other causes, idiopathic hirsutism is the most probable diagnosis.