INVESTIGATIONS, TREATMENT PLAN & KEY INFORMATION
INVESTIGATIONS
• Freeman-Galloway scoring system
• Ultrasound: >20 follicles in one ovary (PCOS)
• SHBG
• Serum total testosterone o Early morning testosterone + free testosterone if normal but high suspicion
• Early morning 17-hydroxyprogesterone if congenital adrenal hyperplasia is suspected
TREATMENT PLAN
2-week wait referral if:
• Signs of androgen-secreting tumours o Rapid onset symptoms o Abdominal/pelvic mass o Virilisation
• Testosterone >6.7nmol/L General endocrine referral if:
• Testosterone >4nmol/L
• Increased 17-hydroxyprogesterone
• Underlying aetiology requiring secondary care diagnosis/treatment Medical management:
• Eflornithine: 6-8 week trial (contraindicated in pregnancy) o Stop if no better after 4 months
• Combined oral contraceptives containing ethinylestradiol (e.g. Dianette) o Review at 6 months, if no improvement: stop and refer • Post-menopausal women: refer
KEY INFORMATION
• 2-week wait if rapid onset, virilisation, or pelvic mass
• The most common cause is PCOS
• Testosterone levels are crucial for diagnosis
• Treatment depends on the severity and underlying cause.