What laboratory workup is recommended for a 30-year-old female with hyperhidrosis, hair loss, and cystic acne?

From the Guidelines

For a 30-year-old female presenting with hyperhidrosis, hair loss, and cystic acne, I recommend a laboratory workup focused on hormonal evaluation, particularly for polycystic ovary syndrome (PCOS) and other endocrine disorders. The initial panel should include total and free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, 17-hydroxyprogesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, thyroid-stimulating hormone (TSH), and free T4, as suggested by 1. A comprehensive metabolic panel and complete blood count should also be ordered to assess overall health status. Additionally, fasting glucose, hemoglobin A1c, and lipid profile are important to evaluate for metabolic syndrome, which commonly accompanies hormonal disorders, as noted in 1. If PCOS is suspected, a pelvic ultrasound may be warranted to evaluate for ovarian cysts, as recommended in 1. Morning cortisol levels can help rule out Cushing's syndrome, which can present with similar symptoms. This comprehensive workup is essential because the constellation of symptoms suggests an underlying hormonal imbalance, particularly androgen excess, which is characteristic of conditions like PCOS, as discussed in 1. Elevated androgens can stimulate sebaceous glands leading to acne, affect hair follicles causing hair loss, and potentially exacerbate hyperhidrosis, as mentioned in 1. Early identification of the underlying cause will guide appropriate treatment strategies to address both the hormonal imbalance and the troublesome symptoms. Some key points to consider in the workup and management include:

• The importance of evaluating for hyperandrogenism, as it is a common cause of acne, hair loss, and other symptoms, as noted in 1
• The potential benefits of hormonal therapies, such as oral contraceptives, in managing symptoms and regulating menstrual cycles, as discussed in 1
• The need for careful patient selection and monitoring when using certain medications, such as spironolactone, to minimize risks and optimize benefits, as recommended in 1

From the Research

Laboratory Workup for Hyperhidrosis, Hair Loss, and Cystic Acne

To approach a 30-year-old female patient presenting with hyperhidrosis, hair loss, and cystic acne, a comprehensive laboratory workup is essential to rule out underlying causes and guide treatment. The following tests are recommended based on the patient's symptoms:

• Hyperhidrosis:
  • No specific laboratory tests are recommended for primary hyperhidrosis 2, 3. However, it is crucial to rule out secondary causes of hyperhidrosis, which may include:
    • Thyroid function tests (TFTs) to evaluate for hyperthyroidism
    • Complete blood count (CBC) to assess for anemia or infection
    • Blood glucose and insulin levels to evaluate for diabetes or insulin resistance
• Hair Loss:
  • Laboratory tests to evaluate for underlying causes of hair loss may include:
    • Thyroid function tests (TFTs) to evaluate for hypothyroidism or hyperthyroidism 4
    • Iron studies (ferritin, iron, total iron-binding capacity) to assess for iron deficiency
    • Complete blood count (CBC) to evaluate for anemia
    • Androgen hormone panel (testosterone, dihydrotestosterone, androstenedione) to evaluate for androgenetic alopecia
• Cystic Acne:
  • Laboratory tests to evaluate for underlying causes of cystic acne may include:
    • Lipid profile to assess for dyslipidemia 5
    • Fasting blood glucose (FBG) to evaluate for insulin resistance
    • Hormonal panel (testosterone, dihydrotestosterone, androstenedione, cortisol) to evaluate for polycystic ovary syndrome (PCOS) or other hormonal imbalances
    • Insulin sensitivity tests (e.g., HOMA-IR index) to evaluate for insulin resistance 5

Additional Considerations

It is essential to consider the patient's medical history, family history, and physical examination findings when interpreting laboratory results and guiding treatment. A comprehensive approach to managing hyperhidrosis, hair loss, and cystic acne may involve a combination of medical, surgical, and lifestyle modifications.