Hirsutism

A 22-year-old woman presents to the Endocrine Clinic with concerns about unexplained weight gain of 5 kg over the past 8 months despite no significant change in her diet and regular exercise. She is distressed by worsening acne, for which she uses topical clindamycin, and the recent appearance of coarse, dark hair on her upper lip and chin. She reports irregular menstrual cycles, ranging from 35 to 50 days, since menarche. A urine pregnancy test is negative. A random point-of-care blood glucose measurement in the clinic is 145 mg/dL. Which investigation is most likely to point to the underlying diagnosis?

A 22-year-old woman for excessive facial hair growth and severe acne that has worsened over the past two years. She has been managing the hair with threading and the acne with over-the-counter creams, with little success. On examination, her BMI is 30.5 kg/m². Her blood pressure is elevated at 158/95 mmHg, with a regular pulse of 82/min. She exhibits hirsutism involving the upper lip, chin, chest, and lower abdomen. Her abdominal skin shows no striae. Pelvic examination reveals normal external genitalia without clitoromegaly. She reports oligomenorrhea, with cycles every 2-3 months, accompanied by heavy menstrual bleeding.
Which one of the following would be an appropriate initial investigation?

A 23-year-old woman presented with concerns about excessive facial and chest hair, severe acne, and infrequent menstrual periods. She reports having a period only once every three to four months, which is often very heavy. She is not sexually active and has no desire for pregnancy in the near future. On examination, her blood pressure is 158/92 mmHg, and her pulse is 78/min and regular. Her BMI is 33 kg/m².

Investigations:

Given the likely diagnosis, which of the following is the most appropriate intervention to control her symptoms?