QuestionSBA
QuestionChoice
PCOS can be diagnosed if at least two of the following criteria are met:

* Polycystic ovaries (>12 cysts seen on imaging or ovarian volume >10 cubic cm)
* Oligo-/anovulation
* Clinical or biochemical features of hyperandrogenism

Although this patient has some features of hyperandrogenism, such as hirsutism and a slightly elevated BMI, she has normal ovaries and normal menstrual function. Thus, she meets only one of the above criteria. In addition, she has normal LH, FSH and testosterone levels. These make PCOS unlikely.
10025352
c
Polycystic ovary syndrome (PCOS)
QuestionChoice
This is the correct answer. Excessive hair growth may be hereditary and familial in some cases, without a specific underlying medical cause. This is more likely if there is a family history of hirsutism, although this is unknown from this vignette. Menstrual function and hormonal investigations are normal, suggesting that there are no underlying endocrine or gynaecological disorders.
10025350
a
Idiopathic or familial hirsutism
QuestionChoice
Drug-induced hirsutism can occur due to the use of certain medications, such as steroids and cyclosporine, that can lead to increased hair growth. It is not associated with antihistamine or paracetamol administration. Furthermore, the normal hormonal and ultrasound findings do not suggest a direct correlation with drug-induced hirsutism.
10025351
b
Drug induced hirsutism
QuestionChoice
CAH typically results in elevated androgen levels due to an enzymatic deficiency in the adrenal glands, leading to virilising effects. However, in this patient, normal hormone levels are observed. CAH is also more likely to lead to irregular menstrual periods or even amenorrhea due to hormonal imbalances. This patient reports regular, albeit lengthy, menstrual cycles.
10025353
d
Congenital adrenal hyperplasia (CAH)
QuestionChoice
Cushing's disease is an endocrine disorder normally caused by an ACTH-secreting pituitary adenoma, leading to excessive cortisol production. It typically presents with symptoms related to excess cortisol production, such as weight gain, central obesity, easy bruising, and a distinct clinical profile that includes high blood pressure. However, the patient's blood pressure is within normal limits. Although hirsutism is also a feature of Cushing's disease, the patient does not experience other prominent cushingoid symptoms or signs, making Cushing's disease unlikely.
10025354
e
Cushing's disease
Concept
Chapter
2693
5833
Hirsutism
Topic
133
Endocrinology
17468
A 19 year old female attends her GP surgery with concerns about excessive hair on her face and chest. She reports starting her period at 13 years old. These periods usually last 7 days and occur regularly. She takes antihistamines for hay fever during the summer and occasional paracetamol when she has a headache.

She is 162cm tall and weighs 68kg. Her blood pressure, luteinising hormone, follicle-stimulating hormone, prolactin, and testosterone levels are within normal limits. She undergoes a pelvic ultrasound scan which is unremarkable.

Which of the following is the most likely diagnosis?
a