Hirsutism

Lab
DHEAS + --> adrenal tumor (abrupt onset)
17-OH progesterone --> congenital adrenal hyperplasia, 21-hydroxylase deficient
testosterone: mild --> PCOS, markedly -->ovarian tumor(abrupt onset)

PCOS also Stein-Leventhal syndrome
Hx: gradual, family hx, anovulation, bleeding, infertility, diabetes
PE: hirsutism, acne, obesity, palpable ovaries, acanthosis nigricans
Lab: testosterone, LH:FSH>3:1, SHBG decrease
Txt: OCP + metformin, OCP inhibit LH, increase SHBG

Idiopathic: increase 5-alpha reductase, all other labs are normal, Txt: spironolactone, eflornithine