Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity
and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic
ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36 ),
features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have
acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone
(39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml),
elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430
mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have
diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout
for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating
many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus
help in reducing disease morbidity.