Hirsutism laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Rasam Hajiannasab M.D.[2], Ahmed Younes M.B.B.CH [3]

Laboratory tests that should be done in hirsutism include testosterone level, DHEAS, and 24-hour cortisol level.

• Serum testosterone may be normal to increased in case of PCOS and CAH but would be definitely raised (>200 ng/ml) in case of malignant tumor of the adrenal or ovary.^[1]

• Dehydroepiandrosterone sulfate (DHEAS): Raised DHEAS (>700 μg/dl) always indicates an adrenal cause, benign or malignant.

• 17 Hydroxy progesterone: Levels less than 200 ng/dl excludes CAH. Mildly increased levels between 300 and 1,000 ng/dl require an ACTH stimulation test. Cosyntropin (synthetic ACTH), 250 μg, is administered intravenously, and levels of 17-hydroxyprogesterone are measured before and one hour after the injection. Post-stimulation values (>1,000 ng/dl) constitute a positive test.^[1]

• Twenty four hour urine free cortisol should be measured in women with signs and symptoms of Cushing’s syndrome.

• LH/FSH greater than 3 is indicative of PCOS.^[2]

• Serum TSH and Prolactin: Hypothyroidism and hyperprolactinemia can lead to hirsutism.^[3]