Polycystic ovary syndrome differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Polycystic_ovary_syndrome]] | |||
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Polycystic ovary syndrome must be differentiated from other causes of irregular or absent [[menstruation]] and [[hirsutism]], such as [[congenital adrenal hyperplasia]], [[cushing's syndrome]], [[hyperprolactinemia]], and other [[pituitary]] or [[adrenal]] disorders. | Polycystic ovary syndrome must be differentiated from other causes of irregular or absent [[menstruation]] and [[hirsutism]], such as [[congenital adrenal hyperplasia]], [[cushing's syndrome]], [[hyperprolactinemia]], and other [[pituitary]] or [[adrenal]] disorders. | ||
==Differentiating Polycystic | ==Differentiating Polycystic Ovarian Syndrome From Other Diseases== | ||
=== Differentials based on irregular menstruation and hirsutism === | |||
Polycystic ovary syndrome must be differentiated from other causes of irregular or absent [[menstruation]] and [[hirsutism]], such as [[congenital adrenal hyperplasia]], [[cushing's syndrome]], [[hyperprolactinemia]], and other [[pituitary]] or [[Adrenal|adrena]]<nowiki/>l disorders. The table below summarizes the findings that differentiate polycystic ovary syndrome from other conditions that cause irregular or absent [[menstruation]] and [[hirsutism]]:<ref name="pmid11253984">{{cite journal |vauthors=Boscaro M, Barzon L, Fallo F, Sonino N |title=Cushing's syndrome |journal=Lancet |volume=357 |issue=9258 |pages=783–91 |year=2001 |pmid=11253984 |doi=10.1016/S0140-6736(00)04172-6 |url=}}</ref><ref name="pmid11571938">{{cite journal |vauthors=Findling JW, Raff H |title=Diagnosis and differential diagnosis of Cushing's syndrome |journal=Endocrinol. Metab. Clin. North Am. |volume=30 |issue=3 |pages=729–47 |year=2001 |pmid=11571938 |doi= |url=}}</ref><ref name="pmid9793762">{{cite journal |vauthors=Newell-Price J, Trainer P, Besser M, Grossman A |title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states |journal=Endocr. Rev. |volume=19 |issue=5 |pages=647–72 |year=1998 |pmid=9793762 |doi=10.1210/edrv.19.5.0346 |url=}}</ref><ref name="urlHow Is Metabolic Syndrome Diagnosed? - NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health/health-topics/topics/ms/diagnosis |title=How Is Metabolic Syndrome Diagnosed? - NHLBI, NIH |format= |work= |accessdate=}}</ref> | Polycystic ovary syndrome must be differentiated from other causes of irregular or absent [[menstruation]] and [[hirsutism]], such as [[congenital adrenal hyperplasia]], [[cushing's syndrome]], [[hyperprolactinemia]], and other [[pituitary]] or [[Adrenal|adrena]]<nowiki/>l disorders. The table below summarizes the findings that differentiate polycystic ovary syndrome from other conditions that cause irregular or absent [[menstruation]] and [[hirsutism]]:<ref name="pmid11253984">{{cite journal |vauthors=Boscaro M, Barzon L, Fallo F, Sonino N |title=Cushing's syndrome |journal=Lancet |volume=357 |issue=9258 |pages=783–91 |year=2001 |pmid=11253984 |doi=10.1016/S0140-6736(00)04172-6 |url=}}</ref><ref name="pmid11571938">{{cite journal |vauthors=Findling JW, Raff H |title=Diagnosis and differential diagnosis of Cushing's syndrome |journal=Endocrinol. Metab. Clin. North Am. |volume=30 |issue=3 |pages=729–47 |year=2001 |pmid=11571938 |doi= |url=}}</ref><ref name="pmid9793762">{{cite journal |vauthors=Newell-Price J, Trainer P, Besser M, Grossman A |title=The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states |journal=Endocr. Rev. |volume=19 |issue=5 |pages=647–72 |year=1998 |pmid=9793762 |doi=10.1210/edrv.19.5.0346 |url=}}</ref><ref name="urlHow Is Metabolic Syndrome Diagnosed? - NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health/health-topics/topics/ms/diagnosis |title=How Is Metabolic Syndrome Diagnosed? - NHLBI, NIH |format= |work= |accessdate=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Disease | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | ||
!Differentiating Features | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating Features | ||
|- | |- | ||
|[[Pregnancy]] | |[[Pregnancy]] | ||
| | | | ||
* Pregnancy always should be excluded in a patient with a history of [[amenorrhea]] | * Pregnancy always should be excluded in a patient with a history of [[amenorrhea]]. | ||
* Features include amenorrhea or [[oligomenorrhea]], abnormal [[uterine bleeding]], [[Nausea and vomiting|nausea/vomiting]], cravings, [[weight gain]] (although not in the early stages and not if vomiting), [[polyuria]], [[abdominal cramps]] and [[constipation]], [[fatigue]], [[dizziness]]/[[lightheadedness]], and [[Hyperpigmentation|increased pigmentation]] (moles, [[nipples]]) | * Features include amenorrhea or [[oligomenorrhea]], abnormal [[uterine bleeding]], [[Nausea and vomiting|nausea/vomiting]], cravings, [[weight gain]] (although not in the early stages and not if vomiting), [[polyuria]], [[abdominal cramps]] and [[constipation]], [[fatigue]], [[dizziness]]/[[lightheadedness]], and [[Hyperpigmentation|increased pigmentation]] (moles, [[nipples]]). | ||
* [[Uterus|Uterine]] enlargement is detectable on [[abdominal examination]] at approximately 14 weeks of [[gestation]] | * [[Uterus|Uterine]] enlargement is detectable on [[abdominal examination]] at approximately 14 weeks of [[gestation]]. | ||
* [[Ectopic pregnancy]] may cause oligomenorrhea, amenorrhea, or abnormal uterine bleeding with [[abdominal pain]] and sometimes subtle or absent physical symptoms and signs of [[pregnancy]] | * [[Ectopic pregnancy]] may cause oligomenorrhea, amenorrhea, or abnormal uterine bleeding with [[abdominal pain]] and sometimes subtle or absent physical symptoms and signs of [[pregnancy]]. | ||
|- | |- | ||
|Hypothalamic amenorrhea | |Hypothalamic amenorrhea | ||
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* Diagnosis of exclusion | * Diagnosis of exclusion | ||
* Seen in athletes, people on crash diets, patients with significant systemic illness, and those experiencing undue [[stress]] or [[anxiety]] | * Seen in athletes, people on crash diets, patients with significant systemic illness, and those experiencing undue [[stress]] or [[anxiety]] | ||
* Predisposing features are as follows [[weight loss]], particularly if features of [[anorexia nervosa]] are present or the [[BMI]] is <19 kg/m2 | * Predisposing features are as follows [[weight loss]], particularly if features of [[anorexia nervosa]] are present or the [[BMI]] is <19 kg/m2. | ||
* Recent administration of depot [[Medroxyprogesterone acetate|medroxyprogesterone]], which may suppress [[ovarian]] activity for 6 months to a year | * Recent administration of depot [[Medroxyprogesterone acetate|medroxyprogesterone]], which may suppress [[ovarian]] activity for 6 months to a year. | ||
* Use of [[dopamine agonists]] (eg, antidepressants) and major [[tranquilizers]] | * Use of [[dopamine agonists]] (eg, antidepressants) and major [[tranquilizers]] | ||
* [[Hyperthyroidism]] | * [[Hyperthyroidism]] | ||
* In patients with weight loss related to anorexia nervosa, fine hair growth ([[lanugo]]) may occur all over the body, but it differs from [[hirsutism]] in its fineness and wide distribution | * In patients with weight loss related to anorexia nervosa, fine hair growth ([[lanugo]]) may occur all over the body, but it differs from [[hirsutism]] in its fineness and wide distribution. | ||
|- | |- | ||
|[[Primary amenorrhea]] | |[[Primary amenorrhea]] | ||
| | | | ||
* Causes include [[reproductive system]] abnormalities, [[chromosomal]] abnormalities, or [[delayed puberty]] | * Causes include [[reproductive system]] abnormalities, [[chromosomal]] abnormalities, or [[delayed puberty]]. | ||
* If [[secondary sexual characteristics]] are present, an [[anatomic]] abnormality (eg, [[imperforate hymen]], which is rare) should be considered | * If [[secondary sexual characteristics]] are present, an [[anatomic]] abnormality (eg, [[imperforate hymen]], which is rare) should be considered. | ||
* If secondary sexual characteristics are absent, a chromosomal abnormality (eg, [[Turner syndrome]] ) or [[delayed puberty]] should be considered | * If secondary sexual characteristics are absent, a chromosomal abnormality (eg, [[Turner syndrome]] ) or [[delayed puberty]] should be considered. | ||
|- | |- | ||
|[[Cushing's syndrome|Cushing syndrome]] | |[[Cushing's syndrome|Cushing syndrome]] | ||
| | | | ||
* [[Cushing syndrome]] is due to excessive [[glucocorticoid]] secretion from the [[adrenal glands]], either primarily or secondary to stimulation from [[Pituitary gland|pituitary]] or ectopic hormones; can also be caused by exogenous [[steroid]] use | * [[Cushing syndrome]] is due to excessive [[glucocorticoid]] secretion from the [[adrenal glands]], either primarily or secondary to stimulation from [[Pituitary gland|pituitary]] or ectopic hormones; can also be caused by exogenous [[steroid]] use. | ||
* Features include [[hypertension]], [[weight gain]] (central distribution), [[acne]], and abdominal striae Patients have [[ | * Features include [[hypertension]], [[weight gain]] (central distribution), [[acne]], and abdominal striae. Patients may have [[hyponatremia]] and elevated plasma cortisol levels on [[dexamethasone]] suppression testing. | ||
|- | |- | ||
|[[Hyperprolactinemia]] | |[[Hyperprolactinemia]] | ||
| | | | ||
* Mild [[hyperprolactinemia]] may occur as part of [[PCOS]]-related hormonal dysfunction | * Mild [[hyperprolactinemia]] may occur as part of [[PCOS]]-related hormonal dysfunction. | ||
* Other causes include [[stress]], [[lactation]], and use of [[dopamine antagonists]] | * Other causes include [[stress]], [[lactation]], and use of [[dopamine antagonists]]. | ||
* A [[prolactinoma]] of the [[pituitary gland]] is an uncommon cause and should be suspected if [[prolactin]] levels are very high (>200 ng/mL) | * A [[prolactinoma]] of the [[pituitary gland]] is an uncommon cause and should be suspected if [[prolactin]] levels are very high (>200 ng/mL). | ||
* Physical examination findings are usually normal | * Physical examination findings are usually normal. | ||
* As in patients with PCOS, hyperprolactinemia may be associated with mild [[galactorrhea]] | * As in patients with PCOS, hyperprolactinemia may be associated with mild [[galactorrhea]], [[oligomenorrhea]], or [[amenorrhea]]. However, [[galactorrhea]] can occur with [[nipple]] stimulation and/or [[stress]] when prolactin levels are within normal ranges. | ||
* A large [[prolactinoma]] may cause [[headaches]] and [[visual field]] disturbance due to pressure on the [[optic chiasm]] | * A large [[prolactinoma]] may cause [[headaches]] and [[visual field]] disturbance due to pressure on the [[optic chiasm]] resulting in classically a gradually increasing bi-temporal hemianopsia | ||
|- | |- | ||
|Ovarian or adrenal tumor | |Ovarian or adrenal tumor | ||
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|} | |} | ||
=== | ===Differentials based on virilization and hirsutism=== | ||
Polycystic ovarian syndrome must be differentiated from diseases that cause [[virilization]] and [[hirsutism]] in female:<ref name="pmid24830586">{{cite journal |vauthors=Hohl A, Ronsoni MF, Oliveira Md |title=Hirsutism: diagnosis and treatment |journal=Arq Bras Endocrinol Metabol |volume=58 |issue=2 |pages=97–107 |year=2014 |pmid=24830586 |doi= |url=}}</ref><ref name="pmid10857554">{{cite journal |vauthors=White PC, Speiser PW |title=Congenital adrenal hyperplasia due to 21-hydroxylase deficiency |journal=Endocr. Rev. |volume=21 |issue=3 |pages=245–91 |year=2000 |pmid=10857554 |doi=10.1210/edrv.21.3.0398 |url=}}</ref><ref name="ISBN:978-0323297387">{{cite book | last = Melmed | first = Shlomo | title = Williams textbook of endocrinology | publisher = Elsevier | location = Philadelphia, PA | year = 2016 | isbn = 978-0323297387 }}=</ref> | Polycystic ovarian syndrome must be differentiated from diseases that cause [[virilization]] and [[hirsutism]] in female:<ref name="pmid24830586">{{cite journal |vauthors=Hohl A, Ronsoni MF, Oliveira Md |title=Hirsutism: diagnosis and treatment |journal=Arq Bras Endocrinol Metabol |volume=58 |issue=2 |pages=97–107 |year=2014 |pmid=24830586 |doi= |url=}}</ref><ref name="pmid10857554">{{cite journal |vauthors=White PC, Speiser PW |title=Congenital adrenal hyperplasia due to 21-hydroxylase deficiency |journal=Endocr. Rev. |volume=21 |issue=3 |pages=245–91 |year=2000 |pmid=10857554 |doi=10.1210/edrv.21.3.0398 |url=}}</ref><ref name="ISBN:978-0323297387">{{cite book | last = Melmed | first = Shlomo | title = Williams textbook of endocrinology | publisher = Elsevier | location = Philadelphia, PA | year = 2016 | isbn = 978-0323297387 }}=</ref> | ||
Latest revision as of 20:38, 26 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Polycystic ovary syndrome must be differentiated from other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, cushing's syndrome, hyperprolactinemia, and other pituitary or adrenal disorders.
Differentiating Polycystic Ovarian Syndrome From Other Diseases
Differentials based on irregular menstruation and hirsutism
Polycystic ovary syndrome must be differentiated from other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, cushing's syndrome, hyperprolactinemia, and other pituitary or adrenal disorders. The table below summarizes the findings that differentiate polycystic ovary syndrome from other conditions that cause irregular or absent menstruation and hirsutism:[1][2][3][4]
Disease | Differentiating Features |
---|---|
Pregnancy |
|
Hypothalamic amenorrhea |
|
Primary amenorrhea |
|
Cushing syndrome |
|
Hyperprolactinemia |
|
Ovarian or adrenal tumor |
|
Congenital adrenal hyperplasia |
|
Anabolic steroid abuse |
|
Hirsutism |
|
Differentials based on virilization and hirsutism
Polycystic ovarian syndrome must be differentiated from diseases that cause virilization and hirsutism in female:[5][6][7]
Disease name | Steroid status | Other laboratory | Important clinical findings |
---|---|---|---|
Non-classic type of 21-hydroxylase deficiency | Increased:
|
|
|
11-β hydroxylase deficiency | Increased:
Decreased: |
|
|
3 beta-hydroxysteroid dehydrogenase deficiency | Increased:
Decreased: |
|
|
Polycystic ovary syndrome |
|
|
|
Adrenal tumors |
|
|
|
Ovarian virilizing tumor |
|
|
|
Cushing's syndrome |
|
||
Hyperprolactinemia |
|
|
References
- ↑ Boscaro M, Barzon L, Fallo F, Sonino N (2001). "Cushing's syndrome". Lancet. 357 (9258): 783–91. doi:10.1016/S0140-6736(00)04172-6. PMID 11253984.
- ↑ Findling JW, Raff H (2001). "Diagnosis and differential diagnosis of Cushing's syndrome". Endocrinol. Metab. Clin. North Am. 30 (3): 729–47. PMID 11571938.
- ↑ Newell-Price J, Trainer P, Besser M, Grossman A (1998). "The diagnosis and differential diagnosis of Cushing's syndrome and pseudo-Cushing's states". Endocr. Rev. 19 (5): 647–72. doi:10.1210/edrv.19.5.0346. PMID 9793762.
- ↑ "How Is Metabolic Syndrome Diagnosed? - NHLBI, NIH".
- ↑ Hohl A, Ronsoni MF, Oliveira M (2014). "Hirsutism: diagnosis and treatment". Arq Bras Endocrinol Metabol. 58 (2): 97–107. PMID 24830586. Vancouver style error: initials (help)
- ↑ White PC, Speiser PW (2000). "Congenital adrenal hyperplasia due to 21-hydroxylase deficiency". Endocr. Rev. 21 (3): 245–91. doi:10.1210/edrv.21.3.0398. PMID 10857554.
- ↑ Melmed, Shlomo (2016). Williams textbook of endocrinology. Philadelphia, PA: Elsevier. ISBN 978-0323297387.=