Differential Diagnosis for the 16-year-old girl with acne and other symptoms
- Single most likely diagnosis:
- Polycystic Ovary Syndrome (PCOS): This is the most likely diagnosis given the patient's symptoms of acne, irregular menses, and signs of hyperandrogenism (terminal hairs on the upper lip and around the nipples). The patient's obesity and history of weight gain also support this diagnosis, as PCOS is often associated with insulin resistance and metabolic syndrome.
- Other Likely diagnoses:
- Hyperandrogenism-Insulin Resistance-Acanthosis Nigricans (HAIR-AN) syndrome: This syndrome is characterized by hyperandrogenism, insulin resistance, and acanthosis nigricans, which could explain the patient's acne, irregular menses, and obesity.
- Congenital Adrenal Hyperplasia (CAH): Although the patient's serum total testosterone and dehydroepiandrosterone sulfate levels are normal, CAH is still a possible diagnosis, especially if the patient has a non-classic form of the disease.
- Do Not Miss diagnoses:
- Androgen-Secreting Tumor: Although rare, an androgen-secreting tumor (e.g., ovarian or adrenal tumor) could cause the patient's symptoms of hyperandrogenism and should not be missed, as it would require prompt surgical intervention.
- Cushing's Syndrome: This rare endocrine disorder could cause the patient's symptoms of obesity, acne, and irregular menses, and would require prompt diagnosis and treatment to prevent long-term complications.
- Rare diagnoses:
- Acromegaly: This rare endocrine disorder could cause the patient's symptoms of acne, irregular menses, and obesity, although it is less likely given the patient's age and lack of other symptoms such as headaches or visual disturbances.
- Prolactinoma: A rare pituitary tumor that could cause the patient's symptoms of irregular menses and obesity, although it is less likely given the patient's normal serum testosterone and dehydroepiandrosterone sulfate levels.