Differential Diagnosis for Elevated DHEAS in the Absence of PCOS
- Single Most Likely Diagnosis
- Adrenal Hyperplasia: This condition is characterized by the excessive production of androgens, including DHEAS, due to an enzymatic defect in the adrenal gland. It is a common cause of elevated DHEAS levels in individuals without PCOS.
- Other Likely Diagnoses
- Adrenal Tumor: Benign or malignant tumors of the adrenal gland can produce excess androgens, leading to elevated DHEAS levels.
- Cushing's Syndrome: Although more commonly associated with cortisol excess, some forms of Cushing's syndrome can also lead to increased production of androgens, including DHEAS.
- Congenital Adrenal Hyperplasia (CAH) - Late-Onset: A milder form of CAH that may present later in life with symptoms of androgen excess, including elevated DHEAS.
- Do Not Miss Diagnoses
- Adrenal Carcinoma: A rare but potentially life-threatening condition that can cause significant androgen excess, including elevated DHEAS levels. Early detection is crucial for treatment and prognosis.
- Pheochromocytoma with Androgen Excess: Although rare, some pheochromocytomas can co-secrete androgens, leading to elevated DHEAS levels.
- Rare Diagnoses
- Familial Glucocorticoid Resistance: A rare genetic disorder characterized by resistance to glucocorticoids, which can lead to an increase in ACTH and subsequently an increase in androgen production, including DHEAS.
- Other rare adrenal disorders or tumors that can produce androgens, such as adrenal rest tumors in individuals with a history of CAH.