Which disorders should be included in the differential diagnosis of polycystic ovarian syndrome (PCOS)?

Updated: Sep 19, 2019
  • Author: Richard Scott Lucidi, MD, FACOG; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

Although no agreed-upon diagnostic criteria currently exist for adolescent polycystic ovarian syndrome (PCOS), hyperandrogenemia is essential for the diagnosis in this age group. [45]

All conditions that mimic PCOS should be ruled out before a diagnosis of PCOS is confirmed. Consider the following in the differential diagnosis of PCOS:

  • Ovarian hyperthecosis

  • Congenital adrenal hyperplasia (late-onset)

  • Drugs (eg, danazol, androgenic progestins)

  • Patients with menstrual disturbances and signs of hyperandrogenism

  • Idiopathic hirsutism

  • Familial hirsutism

  • Masculinizing tumors of the adrenal gland or ovary (rapid onset of signs of virilization)

  • Cushing syndrome (low K+, striae, central obesity, high cortisol; high androgens in adrenal carcinoma)

  • Exogenous anabolic steroid use

  • Stromal hyperthecosis (valproic acid)

Although obesity itself is not considered part of the differential diagnosis, obesity is associated with insulin resistance or any condition that is associated with severe insulin resistance (eg, insulin receptoropathies), which may clinically manifest in the same way as PCOS. Obesity may unmask features of PCOS in women who are genetically predisposed to this syndrome.


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