Approach to patients with hirsutism.

Hirsutism is a common medical condition that in most women is due to the polycystic ovary syndrome or is idiopathic. For a few women, hirsutism signals a serious underlying disorder such as an ovarian or adrenal tumor, congenital adrenal hyperplasia, or Cushing's syndrome. A detailed medical history and examination can identify women in whom a serious disease is suspected and for whom laboratory evaluation is warranted. Measurements of serum testosterone, dehydroepiandrosterone, and 17 alpha-hydroxyprogesterone levels, and 24-hour urinary cortisol concentrations are important screening tests. Therapy is directed at suppressing ovarian or adrenal androgen production, inhibiting the conversion of testosterone to dihydrotestosterone, or antagonizing the effects of androgens at the receptor level.