A prospective study of the prevalence of clear‐cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia

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Abstract
OBJECTIVE To determine the frequency of polycystic ovaries (PCO) on ultrasound and the incidence of clear-cut endocrine disorders leading to virilization in patients complaining of hirsutism or androgenic alopecia. The major purpose was to determine a coherent policy for the routine biochemical assessment of such women. DESIGN A prospective study of women attending a joint skin/endocrine clinic complaining of these problems. PATIENTS Three hundred and fifty consecutive women with hirsutism and/or androgenic alopecia were assessed. MEASUREMENTS Baseline endocrine screens were conducted on two occasions and included measurement of serum testosterone, androstenedione, dehydroepiandrosterone sulphate, sex hormone binding globulin, LH, FSH, 17-hydroxyprogesterone and PRL. The ovarles were visualized by high-resolution pelvic ultrasound scanning. RESULTS Eight women were identified with relevant endocrine disorders; of these, one was acromegalic and one had a microprolactinoma—In both cases the association may have been fortuitous. Three had clear-cut 21-hydroxylase deficiency, one a rare hepatic enzyme deficiency (11-reductase), one a virilizing adrenal carclnoma and one a Leydig cell tumour. The latter six cases all had persistently elevated levels of serum testosterone (>5nmol/l). In ail, 13 women had baseline testosterone levels in excess of 5nmol/l. Polycystic ovaries were present in 81 % of the cases who had erratic cycles and 52% of those with regular cycles; PCO were present In two of the women with 21-hydroxylase deficiency and In the woman with 11-oxoreductase deficiency. The Leydig cell tumour (1.2 cm diameter) was not detected on ultrasound or CT scan. CONCLUSIONS For the exclusion of enzyme deficiencies and virllizing tumours clinical assessment and a single serum testosterone measurement will suffice.