Patient presentation: Panel discussion

Mrs. E. M., a 19-year-old, white, para 0, gravida 1 woman whose expected date of confinement was August 1, 1971, was first examined on February 5. The menstrual periods had been regular until conception occurred. Nothing unusual was noted about her physique, hair distribution, secondary sex characteristics, or voice. On March 29, at a routine obstetric visit, she stated that she had noticed increased hair growth on her face and body, confirmed by examination. She was reassured that most of this would regress after delivery. When seen next on April 26, however, it was immediately apparent that the virilization changes were far beyond normal limits. There was marked growth of coarse dark hair on her face and body, the pubic hair growth was very dense and coarse, and the clitoris was enlarged. Her face had changed remarkably in appearance. There was acne and thickening of the features. Her voice was very deep. Within the next week, the following laboratory studies were performed (all normals listed are for nonpregnant