Differential Diagnosis for a Female with Hirsutism and Heavy Periods
- Single most likely diagnosis:
- Idiopathic hirsutism: This condition is characterized by excessive hair growth in women without an identifiable cause, such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, or androgen-secreting tumors. The patient's normal testosterone levels and absence of polycystic ovaries support this diagnosis.
- Other Likely diagnoses:
- Androgen excess due to other causes (e.g., adrenal disorders): Although the patient's testosterone levels are normal, other androgens might be elevated, causing hirsutism.
- Thyroid disorders: Hypothyroidism, in particular, can cause heavy periods and potentially contribute to hirsutism.
- Hyperprolactinemia: Elevated prolactin levels can disrupt menstrual cycles, leading to heavy periods, and may also contribute to hirsutism.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Androgen-secreting tumors: Although rare, these tumors can cause significant androgen excess, leading to hirsutism and other symptoms. Missing this diagnosis could lead to delayed treatment and potentially life-threatening consequences.
- Cushing's syndrome: This rare endocrine disorder can cause hirsutism, heavy periods, and other symptoms due to excess cortisol production.
- Rare diagnoses:
- Congenital adrenal hyperplasia (late-onset): This genetic disorder can cause androgen excess, leading to hirsutism and other symptoms.
- Acromegaly: Although rare, this condition can cause heavy periods and potentially contribute to hirsutism due to excess growth hormone production.