Differential Diagnosis for Hirsutism and Recurrent Hypoglycemia

Single Most Likely Diagnosis

• Polycystic Ovary Syndrome (PCOS): This condition is characterized by hyperandrogenism (leading to hirsutism), ovulatory dysfunction, and polycystic ovaries. While hypoglycemia is not a primary feature, insulin resistance, which is common in PCOS, can lead to fluctuations in blood glucose levels, potentially causing hypoglycemia, especially in the context of insulin therapy or excessive insulin secretion.

Other Likely Diagnoses

• Cushing's Syndrome: This endocrine disorder results from excess cortisol and can cause hirsutism due to the androgenic effects of cortisol. Hypoglycemia can occur, particularly in the morning, due to the diurnal variation of cortisol levels affecting glucose metabolism.
• Congenital Adrenal Hyperplasia (CAH): This group of inherited disorders affects the adrenal glands, leading to an imbalance in the production of steroid hormones, including androgens. Some forms of CAH can cause hirsutism and, due to the imbalance in steroid hormones, potentially lead to hypoglycemia, especially in the context of adrenal insufficiency.

Do Not Miss Diagnoses

• Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to recurrent episodes of hypoglycemia. While not directly causing hirsutism, the metabolic disturbances could potentially exacerbate or be associated with conditions that lead to hirsutism. Missing this diagnosis could be life-threatening due to the risk of severe hypoglycemia.
• Adrenal Insufficiency: This condition, including Addison's disease, can lead to hypoglycemia due to the lack of cortisol, which is essential for glucose metabolism. Hirsutism can be present in some cases, particularly if there is an imbalance in the production of adrenal androgens.

Rare Diagnoses

• Stromal Ovarian Tumors: Rare ovarian tumors that can produce androgens, leading to hirsutism. Some of these tumors can also produce insulin or insulin-like growth factor, potentially causing hypoglycemia.
• McArdle's Syndrome (Glycogen Storage Disease Type III): A rare genetic disorder affecting glycogen metabolism, which can lead to hypoglycemia. While not directly associated with hirsutism, the metabolic disturbances could potentially contribute to or exacerbate conditions leading to hirsutism in rare cases.