Hirsutism, virilism, congenital adrenal hyperplasia, PCOS

1. Big picture

This topic is about androgen excess in women. In the exam, the key is to separate common benign androgen excess from dangerous rapidly progressive androgen excess.

The most common clinical pattern is:

young woman + irregular menses + hirsutism/acne ± obesity/insulin resistance → think PCOS

But the dangerous pattern is:

rapid-onset hirsutism + virilization + very high testosterone or DHEA-S → think androgen-secreting ovarian/adrenal tumor until proven otherwise

The examiner wants you to know:

1. What is hirsutism and how it differs from hypertrichosis and virilism.
2. How to investigate female androgen excess step by step.
3. How to recognize PCOS clinically and diagnostically.
4. How to distinguish PCOS from congenital adrenal hyperplasia, especially non-classic 21-hydroxylase deficiency.
5. Which congenital adrenal hyperplasia forms cause salt wasting and which cause hypertension/hypokalemia.
6. Treatment logic: cosmetic + hormonal suppression + antiandrogen + fertility/metabolic management.

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