Differential Diagnosis
- Single most likely diagnosis
- Congenital Adrenal Hyperplasia (CAH): The patient's elevated 17-hydroxyprogesterone level is a strong indicator of CAH, which can cause adrenal hyperplasia and potentially lead to the development of adrenal rests or cysts in the kidneys and ovaries. The complicated ovarian cysts and the initial elevated cortisol and DHEAS levels also support this diagnosis.
- Other Likely diagnoses
- Polycystic Ovary Syndrome (PCOS): The presence of complicated ovarian cysts and the patient's hormonal profile (elevated DHEAS and cortisol) could be consistent with PCOS, although the kidney lesions are not typically associated with this condition.
- Adrenal incidentaloma: The patient's initial elevated cortisol and DHEAS levels could be indicative of an adrenal tumor, which might be related to the hypoattenuating lesions on the left kidney.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pheochromocytoma: Although less likely, pheochromocytoma can cause hypertension and hormonal imbalances. The patient's blood pressure is currently normal, but this diagnosis should be considered due to its potential severity.
- Adrenal carcinoma: This rare but aggressive tumor can cause hormonal imbalances and should be ruled out due to its potential for severe consequences.
- Rare diagnoses
- McCune-Albright syndrome: This rare genetic disorder can cause adrenal hyperplasia, ovarian cysts, and other endocrine abnormalities, but it is typically associated with other distinctive features such as café-au-lait spots and fibrous dysplasia.
- Primary pigmented nodular adrenocortical disease (PPNAD): This rare condition can cause adrenal hyperplasia and Cushing's syndrome, but it is often associated with other genetic disorders such as Carney complex.