What is the diagnosis and management for a 31-year-old female (F) with hyperandrogenism, specifically elevated Dehydroepiandrosterone (DHEA) and testosterone levels, presenting with infertility?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: May 13, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for 31F with Elevated DHEA, Elevated Testosterone, and Infertility

Single Most Likely Diagnosis

  • Polycystic Ovary Syndrome (PCOS): This is the most likely diagnosis given the patient's symptoms of elevated androgens (DHEA and testosterone) and infertility. PCOS is a common endocrine disorder in women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.

Other Likely Diagnoses

  • Congenital Adrenal Hyperplasia (CAH): Although less common than PCOS, CAH can cause elevated DHEA and testosterone levels due to adrenal gland dysfunction. It's essential to consider this diagnosis, especially if the patient has a family history or other symptoms like virilization.
  • Androgen-Secreting Tumors: Ovarian or adrenal tumors can produce excess androgens, leading to elevated DHEA and testosterone levels. These tumors are relatively rare but can cause significant symptoms and infertility.
  • Cushing's Syndrome: This rare endocrine disorder is caused by excess cortisol production, which can also lead to elevated androgen levels. However, Cushing's syndrome typically presents with other symptoms like weight gain, hypertension, and glucose intolerance.

Do Not Miss Diagnoses

  • Adrenal Carcinoma: Although rare, adrenal carcinoma can produce excess androgens and has a poor prognosis if left untreated. It's crucial to consider this diagnosis to avoid delayed treatment.
  • Pituitary Tumors: Pituitary tumors, such as prolactinomas or non-functioning adenomas, can disrupt normal pituitary function, leading to elevated androgen levels and infertility.

Rare Diagnoses

  • 17,20-Desmolase Deficiency: This rare genetic disorder affects the production of androgens and can cause elevated DHEA and testosterone levels.
  • Gonadal Dysgenesis: This condition is characterized by abnormal gonadal development, which can lead to elevated androgen levels and infertility.
  • Hyperthecosis: A rare condition where the ovarian stroma produces excess androgens, leading to elevated DHEA and testosterone levels.

Related Questions

Why does pituitary adenoma-induced Cushing's syndrome (Cushing's) exhibit resistance to a low-dose dexamethasone (Dexamethasone) suppression test but not to a high-dose test, differing from other causes of Cushing's syndrome?
What is the role of fluid resuscitation in the management of compartment syndrome?
What is the Warburg effect?
What is the next step in treatment for persistent knee pain unresponsive to conservative therapy with a normal knee radiograph (x-ray)?
What is the significance of an elevated Luteinizing Hormone (LH) level of 63?
What is the best treatment for a 38-year-old male with worsening contact dermatitis unresponsive to Triamcinolone (triamcinolone)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question