Polycystic Ovary Syndrome and the Differential Diagnosis of Hyperandrogenism

The document from 2013 outlines the diagnostic challenges of polycystic ovary syndrome (PCOS) due to its symptom overlap with other hyperandrogenic conditions. It states that PCOS is the most prevalent cause of hyperandrogenism, which includes symptoms like hirsutism, alopecia, acne, and menstrual irregularities. Diagnosis of PCOS follows the Rotterdam criteria, which require two out of three features: oligomenorrhea or anovulation, evidence of hyperandrogenism, and polycystic ovaries on ultrasound. The document critiques the reliability of testosterone measurement by immunoassays, which often overestimate levels, and notes that mass spectrometry is more accurate but less accessible. It also recommends using the Ferriman-Gallwey score to objectively grade hirsutism. Other conditions causing hyperandrogenism, such as congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumors, are discussed. The document concludes that careful clinical judgment is essential for accurate diagnosis and that testosterone levels around 2-5 nmol/l suggest PCOS, while levels above 5 nmol/l may indicate other conditions. Misdiagnosis can lead to significant consequences for fertility and overall health.