The presence of terminal hair with a male pattern of distribution in a women is called hirsutism, and is either due to increased androgen production or to increased sensitivity of the hair follicle to androgens. In more than 95% of cases, it is a benign condition, generally a polycystic ovarian syndrome. When there is no evidence of oligo-anovulation and androgen levels are normal, the diagnosis of idiopathic hirsutism is given. In both situations, treatment is threefold: 1) inhibition of androgen production; 2) inhibition of androgen action and 3) a local treatment. The brisk apparition and extension of hirsutism, together with signs of virilisation and high levels of circulating androgens, suggest the presence of a tumor, extremely rare, but almost always malignant.
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