A 45-year-old woman comes to the office due to 3 months of excessive hair growth over her face and body. Her
last menstrual period was 4 months ago. The patient’s menstrual cycle had previously been regular, and she has
had 2 successful pregnancies. Medical history includes hypothyroidism, for which she takes a stable dose of
levothyroxine; a recent TSH level was normal. The patient has smoked half a pack of cigarettes dai y for 25 years.
Blood pressure is 124/82 mm Hg and pulse is 72/min. BMI is 24 kg/m2• The patient is muscular and has an
enlarged clitoris. There is temporal balding, and a large amount of coarse terminal hair is present on the face,
back, chest, and lower abdomen. The remainder of the physical examination is normal. Urine pregnancy test is
negative. Which of the following is the best next step in evaluation of this patient?
- O A. ACTH stimulation test
- O B. CT scan of the abdomen
- 0 C. Insulin-like growth factor 1 level
- Q D. LH to FSH ratio
- O E. Testosterone and dehydroepiandrosterone sulfate levels
0 voters