Hyperandrogenism is a necessary aspect of PCOS. The differential diagnosis of PCOS is the differential diagnosis of hyperandrogenism as well as ddx of other features of PCOS such as ovulatory dysfunction. The differential diagnosis of PCOS includes both endocrine and malignant causes.
All conditions that mimic PCOS must be ruled out before a diagnosis of PCOS is confirmed.
- PCOS
- Pregnancy
- Physiologic adolescent anovulation
- Insulin-resistance disorders
- Thyroid dysfunction / Hypothyroidism
- Hyperprolactinemia
- Cushing syndrome
- Congenital adrenal hyperplasia (late-onset)
- Congenital disorders of adrenal steroid metabolism or action – e.g. Glucocorticoid resistance, DHEA sulfotransferase deficiency, etc.
- Androgen-secreting tumors / Masculinizing tumors of the adrenal gland or ovary (rapid onset of signs of virilization)
- Hypothalamic amenorrhea
- Primary ovarian insufficiency
- Acromegaly
- Idiopathic hirsutism
- Familial hirsutism
- Exogenous anabolic steroid use -“Anabolic steroids cause virilization in women and may present with features similar to those of virilizing tumors”. UTD
- Drugs (eg, danazol, androgenic progestins)
- Ovarian hyperthecosis
- Stromal hyperthecosis (valproic acid)
- Idiopathic hyperandrogenism – these pts have hyperandrogenism but no identifiable ovarian or adrenal source of androgen despite thorough testing. Those who present with hirsutism and normal menses, but lack a polycystic ovary, are traditionally given this diagnosis.
Differential diagnoses of hyperandrogenism
- PCOS
- Congenital adrenal hyperplasia
- Cushing’s syndrome
- Androgen-secreting tumor (Adrenal/Ovarian origin)
- Exogenous androgen administration
- Gestational hyperandrogenism
- Ovarian hyperthecosis
https://www.aafp.org/afp/2016/0715/p106.html