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Differential Diagnosis

The patient presents with irregular periods, unilateral pelvic pain, hirsutism (dark hair on the chin), and significant weight gain. The following differential diagnoses are considered:

  • Single Most Likely Diagnosis

    • Polycystic Ovary Syndrome (PCOS): This condition is characterized by irregular menstrual cycles, hirsutism, and weight gain, all of which are present in this patient. The normal FSH and LH levels do not rule out PCOS, as these hormone levels can fluctuate.

  • Other Likely Diagnoses

    • Thyroid Dysfunction: Although the TSH and T4 were normal, thyroid dysfunction can sometimes present with irregular periods and weight gain. It's possible that the thyroid nodule could be causing subtle thyroid hormone imbalances not detected by initial tests.
    • Adrenal Disorders: The negative dexamethasone suppression test and normal cortisol levels make Cushing's syndrome less likely, but other adrenal disorders could potentially cause hirsutism and irregular periods.
    • Insulin Resistance: Often associated with PCOS, but can also be a standalone condition leading to weight gain and menstrual irregularities.

  • Do Not Miss Diagnoses

    • Ovarian Tumors: Although rare, ovarian tumors can cause hormonal imbalances leading to irregular periods, hirsutism, and weight gain. The unilateral pelvic pain could be indicative of an ovarian issue.
    • Pituitary Tumors: A pituitary tumor could affect hormone production, leading to the patient's symptoms. The normal FSH, LH, and thyroid tests do not rule out a pituitary issue, as some tumors may not significantly alter these hormone levels.
    • Cushing's Syndrome (despite negative test): Although the dexamethasone suppression test was negative, Cushing's syndrome can be intermittent, and a single negative test does not completely rule out the diagnosis.

  • Rare Diagnoses

    • Congenital Adrenal Hyperplasia (CAH): A genetic disorder affecting the adrenal glands, leading to an imbalance of hormones, which could explain the hirsutism and menstrual irregularities.
    • Hyperandrogenism due to other rare causes: Such as steroid-producing tumors or other genetic disorders affecting hormone production.

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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.

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