D2 MTE3 Case 9: A case of hirsutism…

A 21-year young lady is under our follow up for last three years. Initially, she presented with oligomenorrhea, hirsutism and acne for 2 years. She had weight gain of 10 kgs She was on OCP for oligomenorrhea and underwent laser therapy for hirsutism. On examination, she was obese with acanthosis. Her modified FGS was 16/36 with acne over face and upper back. She did not have any signs of virilization. Her initial hormonal profile in 2018 showed an elevated total testosterone (92 ng/dl) free testosterone (2.13 ng/dl) and DHEAS (720 mcg/dl). She has lost approx. 20 kgs over the last 2 years with life style modifications. She has regular menstrual cycles since one year. However her hirsutism has not improved. Repeat DHEAS is >1000 mcg/dl. Ultrasound abdomen and pelvis showed multiple follicles in both ovaries. Her thyroid profile, Prolactin and 17 OH progesterone are normal. In view of high, tumoral range DHEAS, CT abdomen and pelvis was done which was normal. She was given inj leuprolide 3.75 mcg SC and repeat DHEAS showed significant drop to 400 mcg/dl. Should we have done Dexamethasone suppression test first? What is the management plan?