A 15-year-old Afro-American girl presented for evaluation of increasing facial hair of 2 years' duration. Initially, she applied a topical depilatory sporadically, but now required its use twice weekly. Menarche occurred at age 11 years but menstrual periods were irregular, often with very heavy flow. There were no exposures to topical or systemic androgens, estrogens, or glucocorticoids. The mother had similar complaints: she had applied a topical depilatory to her face for 32 years. Family history was also pertinent for obesity in several family members and maturity-onset diabetes of youth in the patient's brother.
Her height and weight were 151.8 cm (≈5th percentile for age) and 72.5 kg (≈90th percentile for age), respectively. Her blood pressure was 124/73 mm Hg. Her hirsutism score1 was 13: there was sideburn hair; coarse facial hair over the cheeks, upper neck, and chest; and mild facial