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Hirsutism is a frequent and distressing presenting symptom in women, often in the setting of menstrual irregularity and acne. While polycystic ovarian syndrome is a common cause, the differential diagnosis of hirsutism is wide ranging and requires a thorough history and appropriate investigations to exclude potentially serious underlying causes. Several serious underlying conditions require active exclusion, otherwise patients are at risk of missed diagnosis and long-term sequelae of the untreated primary disease. The authors present a case of acromegaly where longstanding hirsutism was the presenting symptom. [ABSTRACT FROM AUTHOR]