Further investigations based on clinical suspicion
| SYSTEMIC CAUSES | INITIAL INVESTIGATIONS |
|---|---|
| Thyroid disease (hyperthyroidism or hypothyroidism) | Sensitive thryroid-stimulating hormone test |
| Polycystic ovary syndrome | Free testosterone, DHEAS, luteinizing hormone: follicle-stimulating hormone>3:1 |
| Coagulopathies, leukemia, thrombocytopenia | Complete blood count, INR, partial thromboplastin time, bleeding time |
| Pituitary adenoma or hyperprolactinemia | Fasting prolactin |
| Hypothalamic suppression due to stress, weight loss, excessive exercise, eating disorder | Measure weight |
| Hepatic disease | Liver function tests, INR |
| Renal disease | Creatinine |
| Adrenal hyperplasia | DHEAS, free testosterone |
| Cushing disease | 24-hour urine free cortisol, overnight dexamethasone suppression test |
DHEAS—dehydroepiandrosterone, INR—international normalized ratio.