Table 3.

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.