Hirsutism commonly affects adolescent girls and necessitates careful assessment and tailored investigation. Management varies, depending on the severity, aetiology and individual patient factors. The psychological and social impact of hirsutism should be sought in all and appropriate support offered. Working with patients to understand the chronic nature of hirsutism and likely outcome of the available therapies may improve patient satisfaction.

Which of the following are features of non-classic congenital adrenal hyperplasia? You may choose more than one answer.

Increased muscle mass.

Advanced bone age.

Hyponatraemia.

Raised 21-hydroxylase.

Raised 17-hydroxyprogesterone.

A 15-year-old patient attends with concerns about dark hairs on her chin and abdomen. You find mild hirsutism on examination. She attained menarche at 11 years old and thinks she has only had two periods in the last year. You suspect she has polycystic ovary syndrome (PCOS). Which of the following is the most appropriate approach to investigation?

Pelvic ultrasound.

No investigations needed, PCOS is a clinical diagnosis.

Testosterone and sex hormone-binding globulin.

Androgen panel (17OHP, androstenedione, DHEAS and testosterone).

No investigations needed, unable to diagnose PCOS at this age.

Regarding pharmacological treatment of hirsutism, which statement is the most correct?

Flutamide is a second-line treatment.

Oral contraceptive use alone will get decrease existing terminal hair.

Metformin is a useful adjunct for the treatment of hirsutism in PCOS.

The antiandrogenic effect of spironolactone is dose dependent.

The progesterone only contraceptive pill can be used if the combined pill is contraindicated or not tolerated.

Which of following statements about cosmetic treatments of hirsutism is correct?

Eflornithine cream works by disrupting the telogen, or resting, phase of hair growth.

Photoepilation is much faster than electrolysis.

Shaving causes hair to grow back thicker.

Photoepilation is effective on pale coloured hairs.

COCPs should be used for at least 9 months before another treatment is considered.

Which of the following may be features of an androgen secreting tumour? You may choose more than one answer.

Insidious onset of symptoms.

Voice change.

Suppressed DHEAS.

Raised androstenedione.

Progression of hirsutism despite treatment.

Answers to the quiz are at the end of the references.