Question

An 18-year-old G0 presents with a one-year history of hirsutism and acne. She had menarche at age 14 and her menses have been irregular every 26-60 days. Her sister has a similar pattern of hair growth. The patient is 5 feet 4 inches tall and weighs 180 pounds. On exam, a few terminal hairs were identified on her chin and upper lip. TSH, prolactin, total testosterone, and DHEAS levels are normal. Which of the following is the most appropriate next test to evaluate this patient's condition?

A. Estradiol levels
B. Serum cortisol levels
C. Urinary cortisol levels
D. Random blood glucose
E. 17-hydroxyprogesterone

Answer 1

The most appropriate next test to evaluate the patient's condition, considering the normal androgen levels, is 17-hydroxyprogesterone to rule out nonclassical congenital adrenal hyperplasia, which shares symptoms with PCOS.

Step-by-step explanation:

Given the clinical picture of hirsutism, acne, irregular menses, and normalization of TSH, prolactin, total testosterone, and DHEAS levels, the most appropriate next test to evaluate the 18-year-old patient suspected of having polycystic ovary syndrome (PCOS) is 17-hydroxyprogesterone.

This test is used to screen for nonclassical congenital adrenal hyperplasia (NCAH), which can mimic PCOS symptoms. Though the symptoms of acne and excess facial hair can be a normal variation in some women, when combined with irregular periods, they suggest the possibility of an endocrine disorder.

PCOS is characterized by high levels of androgens and often associated with increased blood glucose levels. These factors contribute to the aforementioned symptoms and potentially to the development of insulin resistance, which can interfere with ovulation and lead to an irregular menstrual cycle.

However, since the patient's androgen levels were normal, it is required to rule out other conditions with similar presentations. Elevated 17-hydroxyprogesterone would point towards NCAH as a likely cause of her symptoms instead of PCOS.