Imaging for diagnosis of hirsutism

If features suggestive of an androgen-secreting tumour are present, arrange adrenal magnetic resonance imaging (MRI) or computed tomography (CT) to assess for adrenal tumours, and an ovarian ultrasound scan (preferably transvaginal) to assess for ovarian tumours.

In females with hirsutism but no menstrual disturbance or biochemical hyperandrogenism, an ovarian ultrasound scan is indicated to assess or exclude PCOS.

A transvaginal ultrasound scan is preferred over a transabdominal scan for investigation of hirsutism, because it is gives better detail, including more reliable follicle counts used in diagnosis of PCOS. A transabdominal approach is an alternative if a transvaginal scan is not available or is declined.