The Differential Diagnosis of Hirsutism and Virilism

Robert Lang, MD, Fellow in Endocrinology, the Jewish Hospital of St. Louis, and Instructor in Medicine, Washington University School of Medicine: A 25-year-old white housewife was admitted to Jewish Hospital for evaluation of progressive loss of scalp hair. She had been well all of her life, denying any previous hospitalization or difficulties in obtaining insurance policies. Menarche began at age 12 years, and menstruation, although initially scanty, had been subsequently regular at 25-to 30-day intervals. Progressive development of pubic and axillary hair was associated at the age of 14 years with a gradual loss of scalp hair and increased facial hair. By 20 years of age, baldness was so extensive that the patient began wearing a wig and facial hirsutism could only be effectively controlled by shaving daily. Libidinal desires and body weight remained normal and constant, respectively. She was married at the age of 21 years and had normal