A 19-Year-Old Woman Comes to the Office Due to Infrequent

A 19-year-old woman comes to the office due to infrequent menstrual cycles and excessive body hair.  Menarche was at age 11 and her cycles have since been irregular.  The patient has <6 menstrual periods per year with very heavy bleeding.  Her last menstrual period was 4 months ago.  She also reports increased hair growth on her face and trunk.  The patient has no other medical conditions and takes no medications.  She does not use tobacco, alcohol, or illicit drugs.  She is not sexually active.  Family history is significant for hypertension and coronary artery disease in her father and hypertension in her mother.  There is no family history of diabetes mellitus.
Blood pressure is 134/88 mm Hg.  BMI is 30 kg/m².  Acanthosis is present on the nape of the neck.  Significant terminal hair is noted on the face, upper chest, lower abdomen, and lower back.  There are pale striae on the abdominal wall.  The remainder of the physical examination is within normal limits.
Laboratory results are as follows:
Which of the following is the best next step in management of this patient?

A) Order adrenal CT scan
B) Order pelvic ultrasound
C) Prescribe corticosteroids
D) Prescribe metformin
E) Prescribe oral contraceptives