Differential Diagnosis for a 45-year-old Woman with Difficulty Sleeping, Fatigue, and Weight Gain
- Single most likely diagnosis:
- Polycystic Ovary Syndrome (PCOS): The patient's symptoms of weight gain, irregular menstrual periods, and the absence of other symptoms such as hair loss or changes in bowel habits, along with the physical examination findings of an obese abdomen and a symmetrically enlarged uterus, make PCOS a strong consideration. The patient's age and the fact that her last period was 3 months ago also suggest she may be transitioning into perimenopause, but the presence of obesity and irregular periods point more towards PCOS.
- Other Likely diagnoses:
- Hypothyroidism: Although the patient does not report classic symptoms of hypothyroidism such as hair loss or cold intolerance, the weight gain and fatigue could be indicative of this condition. Thyroid function tests would be necessary to confirm this diagnosis.
- Perimenopause: Given the patient's age and the irregularity of her menstrual periods, perimenopause is a possible diagnosis. Symptoms such as difficulty sleeping and fatigue can be associated with hormonal changes during this transition.
- Insulin Resistance: The patient's obesity and the absence of acanthosis nigricans do not rule out insulin resistance, which can lead to fatigue and weight gain. Further testing, such as a glucose tolerance test, would be needed to diagnose insulin resistance or prediabetes.
- Do Not Miss diagnoses:
- Ovarian Cancer: Although less likely, the patient's irregular menstrual periods and the finding of a symmetrically enlarged uterus on bimanual examination necessitate considering ovarian cancer. This diagnosis is critical to not miss due to its potential severity and the importance of early detection.
- Pituitary Tumor: A pituitary tumor could cause hormonal imbalances leading to irregular menstrual periods, weight gain, and fatigue. This diagnosis is crucial to consider due to the potential for serious complications if left untreated.
- Rare diagnoses:
- Cushing's Syndrome: This condition, characterized by excess cortisol production, can lead to weight gain, fatigue, and irregular menstrual periods. However, the absence of other classic symptoms such as striae, buffalo hump, or moon facies makes this diagnosis less likely.
- Adrenal Insufficiency: Although rare, adrenal insufficiency can cause fatigue, weight gain, and irregular menstrual periods. The absence of other symptoms such as skin hyperpigmentation or orthostatic hypotension makes this diagnosis less probable.