Differential Diagnosis of Hyperandrogenism in Women with Polycystic Ovary Syndrome

The document highlights the importance of accurately diagnosing the cause of hyperandrogenism in women who may have Polycystic Ovary Syndrome (PCOS). It explains that while 60-80% of women with PCOS have clinical or laboratory signs of hyperandrogenism, primarily from the ovaries, 20-30% may have increased adrenal production of DHEA-S. The paper outlines diagnostic approaches for conditions like non-classical congenital adrenal hyperplasia (NCCAH), Cushing's disease, and androgen-secreting tumors, and emphasizes the need for specific tests such as serum 17-hydroxyprogesterone levels, ACTH stimulation tests, and dexamethasone suppression tests. It also discusses the prevalence of NCCAH in certain ethnic groups and the importance of screening. The document notes that severe hyperandrogenism and virilization should raise suspicion for androgen-secreting tumors, especially with a recent onset of symptoms and very high serum androgen levels. Additionally, it covers the diagnosis of other conditions like ovarian hyperthecosis, hyperprolactinemia, hypothyroidism, and idiopathic hirsutism, and the importance of measuring serum basal 17-OHP, total testosterone (TST), and DHEA-S levels, as well as evaluating serum prolactin in certain cases. The review did not specify the number of people studied and did not report any conflicts of interest or specific funding.