June 2017 | Case of the month

What other information do you need to know?

• Has this come on gradually or suddenly?
• Is there excess hair elsewhere?
• Are there any anomalies of the menstrual cycle such as amenorrhoea or oligomenorrhoea (menstrual cycles longer than 35 days or fewer than 10 periods a year) 
• Are there any other features of hyperandrogenism?
  • Dermatological manifestations of hyperandrogenism in women include hirsutism, recalcitrant acne, male pattern alopecia and sometimes acanthosis nigricans
  • Non-dermatological manifestations include obesity, irregular menses, a deepening voice, clitoromegaly, increased muscle mass and a decreased breast size
• What medications does the patient take?
  • Drug-related causes include use of androgens, valproic acid, and ciclosporin
• Is there a family history of hirsutism?
   

What investigations are required?

What is the most likely diagnosis?

• The most likely diagnosis is the Polycystic ovarian syndrome
• PCOS is a diagnosis of exclusion. It typically presents in late teenage years in overweight individuals. Two of the following three criteria must be fulfilled for a diagnosis:
  • A clinical diagnosis of amenorrhoea or oligomenorrhoea (menstrual cycles longer than 35 days or fewer than 10 periods a year)
  • Clinical or biochemical (raised FAI, serum testosterone < 4) evidence of hyperandrogenism
  • Polycystic ovaries on ultrasound examination

For further reading on these subjects please refer to the following chapters, which have just been updated:

• Hyperandrogenism
• Hirsutism