Differential Diagnosis for a 31-year-old Female with Mildly Elevated DHEA and Testosterone, Irregular Menses, and Normal Ultrasound of the Uterus and Ovaries

• Single Most Likely Diagnosis
  • Polycystic Ovary Syndrome (PCOS): This is the most likely diagnosis given the symptoms of irregular menses, mildly elevated androgen levels (DHEA and testosterone), and the absence of other significant findings on ultrasound. PCOS is a common endocrine disorder among women of reproductive age and is often associated with hyperandrogenism and ovulatory dysfunction.
• Other Likely Diagnoses
  • Idiopathic Hyperandrogenism: This condition involves elevated androgen levels without a clear cause, such as PCOS, congenital adrenal hyperplasia, or androgen-secreting tumors. It could explain the mildly elevated DHEA and testosterone but would require further investigation to rule out other causes.
  • Anovulatory Cycle: Irregular menses can be due to anovulatory cycles, which might not directly explain the elevated androgen levels but could be a contributing factor to the patient's symptoms.
• Do Not Miss Diagnoses
  • Congenital Adrenal Hyperplasia (CAH): Although less common, CAH can present with hyperandrogenism. It's crucial to consider this diagnosis due to its potential impact on health and the need for specific management. Late-onset CAH might not have been diagnosed in childhood and could present in adulthood with symptoms like irregular menses and hyperandrogenism.
  • Androgen-Secreting Tumors: Although rare, tumors of the ovaries or adrenal glands can produce androgens, leading to elevated levels of DHEA and testosterone. These conditions are critical to diagnose early due to their potential for malignancy and significant impact on health.
• Rare Diagnoses
  • Cushing's Syndrome: This is a rare endocrine disorder caused by excess cortisol levels, which can also lead to an increase in androgen production. It would typically present with additional symptoms such as weight gain, hypertension, and striae.
  • Hyperandrogenism due to Other Rare Conditions: There are several rare genetic and acquired conditions that can lead to hyperandrogenism, such as hyperthecosis, steroidogenic enzyme deficiencies, or exogenous androgen exposure. These would be considered if common causes are ruled out and symptoms persist or worsen.