Differential Diagnosis for the Presented Cases

The cases presented involve patients with obesity, hirsutism, hidradenitis suppurativa, androgenic alopecia, and regular menses, who have a history of polycystic ovary disease (PCOD) that they claim has been treated and cured. Given these symptoms and history, the following differential diagnoses can be considered:

• Single Most Likely Diagnosis

  • Hyperandrogenism: This condition is characterized by excessive levels of androgens, leading to symptoms such as hirsutism, androgenic alopecia, and potentially hidradenitis suppurativa. The presence of regular menses does not rule out hyperandrogenism, as it can occur in women with normal menstrual cycles. The history of treated PCOD could be relevant, but hyperandrogenism can persist or recur.

• Other Likely Diagnoses

  • Congenital Adrenal Hyperplasia (CAH): Although less common, CAH can cause hyperandrogenism. It's essential to consider this, especially if the symptoms persist despite previous treatment for PCOD.
  • Cushing's Syndrome: This rare endocrine disorder can cause hyperandrogenism among other symptoms like obesity and hirsutism. Regular menses might not be affected in mild cases.
  • Idiopathic Hirsutism: Some women develop hirsutism without an identifiable cause, which could be a consideration if other diagnoses are ruled out.

• Do Not Miss Diagnoses

  • Androgen-Secreting Tumors: Although rare, tumors of the ovaries or adrenal glands can produce androgens, leading to the symptoms described. It's crucial to rule out these potentially curable causes of hyperandrogenism.
  • Pituitary or Adrenal Disorders: Other pituitary or adrenal disorders, such as acromegaly or pheochromocytoma, can also lead to hyperandrogenism and should not be missed due to their significant health implications.

• Rare Diagnoses

  • Hyperthecosis: A rare condition where the ovarian stroma is hyperplastic and produces excess androgens, potentially causing the symptoms described.
  • Gonadal Dysgenesis: Certain forms of gonadal dysgenesis can lead to hyperandrogenism, though this would typically be associated with irregular menses or other developmental abnormalities.

Approach to These Cases

1. Detailed History and Physical Examination: Including a thorough review of the patient's previous diagnosis and treatment of PCOD, as well as any family history of similar conditions.
2. Laboratory Tests: To assess androgen levels (e.g., testosterone, DHEA-S), and to rule out other endocrine disorders (e.g., thyroid function tests, cortisol levels).
3. Imaging Studies: Ultrasound or MRI of the ovaries and adrenal glands to rule out tumors.
4. Consultation with Endocrinology: For further evaluation and management, especially if an androgen-secreting tumor or other endocrine disorder is suspected.

Management

Management will depend on the underlying diagnosis but may include:

• Hormonal Treatments: To reduce androgen levels and manage symptoms.
• Anti-androgen Medications: For hirsutism and androgenic alopecia.
• Surgical Intervention: If an androgen-secreting tumor is identified.
• Lifestyle Modifications: Including diet and exercise to manage obesity, which can contribute to hyperandrogenism.