Diagnosis	Percentage of hirsutism cases	Distinguishing historical and clinical clues
Polycystic ovary syndrome	72 to 82	Irregular menses
		Normal to mildly elevated androgen levels
		Polycystic ovaries on ultrasonography
		Central obesity
		Infertility
		Insulin resistance
		Acanthosis nigricans
Idiopathic hyperandrogenemia	6 to 15	Normal menses
		Normal ovaries on ultrasonography
		Elevated androgen levels
		No other explainable cause
Idiopathic hirsutism	4 to 7	Normal menses, androgen levels, and ovaries on ultrasonography
		No other explainable cause
Adrenal hyperplasia	2 to 4	Family history of congenital adrenal hyperplasia
		High-risk ethnic group (e.g., Ashkenazi Jews [1 in 27], Hispanic persons [1 in 40], Slavs [1 in 50])
		Classic form: ambiguous genitalia at birth
		Nonclassic, late-onset form: menstrual dysfunction, oligoanovulation, infertility
		Elevated 17-hydroxyprogesterone level before and after corticotropin stimulation test
Androgen-secreting tumors	0.2	Rapid onset of hirsutism
		Progression of hirsutism despite treatment
		Virilization (e.g., clitoromegaly, increased muscle mass, loss of female body contour)
		Palpable abdominal or pelvic mass
		Early morning total testosterone level greater than200 ng per dL (6.94 nmol per L)
Iatrogenic hirsutism	Uncommon (exact percentage not well-defined in the literature)	Medication history (see Table 2)
Acromegaly	Rare to present with isolated hirsutism	Frontal bossing, increased hand and foot size, mandibular enlargement, coarse facial features, hyperhidrosis, deepened voice
		Elevated serum insulin-like growth factor 1
Cushing syndrome	Rare to present with isolated hirsutism	Central obesity, moon facies, purple skin striae, proximal muscle weakness, acne
		Hypertension, impaired glucose tolerance
		Elevated 24-hour urine free cortisol level
Hyperprolactinemia	Rare to present with isolated hirsutism	Galactorrhea, amenorrhea, infertility
		Elevated prolactin level
Thyroid dysfunction	Rare to present with isolated hirsutism	Hypothyroidism: fatigue, cold intolerance, dry skin, hair loss, myxedema, weight gain, difficulty concentrating, irregular menses
		Hyperthyroidism: hyperactivity, heat intolerance, moist skin, palpitations, oligomenorrhea, goiter, exophthalmos
		Abnormal thyroid function tests