Case 2

  • She denies voice changes or symptoms of Cushing’s syndrome. She does notice increased upper body musculature.
  • Menarche at 11y of age, regular cycles till 4 years ago when she developed amenorrhea.
  • Denies any drug abuse/taking any medications including over the counter supplements.


  • Height 165 cm wt 102 kg BMI 37.3 kg/m2
  • Skin/Hair: loss of hair on scalp from front, FG score 36, acanthosis+, acne+
  • Genital exam: Clitoromegaly, clitoral index 48 mm2, width at the base 4 mm


Question 2

Based on the rapid progression and severity of symptoms, you are concerned for a more sinister cause. Which of the following laboratory tests is most likely to differentiate between an adrenal or ovarian source of excess androgens?

1. 17-hydroxyprogesterone

2. Dehydropiandrosterone sulfate (DHEA-S)

3. Total Testosterone

4. Androstenedione