Match each patient's unique clinical presentation and initial laboratory profile of hyperandrogenism with the most probable underlying diagnosis in order to formulate an accurate differential diagnosis.
- A young adult female is evaluated for a multi-year history of irregular menstrual cycles, progressive facial hair growth, and difficulty losing weight. Laboratory analysis shows a mildly elevated serum free testosterone concentration and a normal dehydroepiandrosterone sulfate (DHEA-S) level.Polycystic ovary syndrome
- A female patient in her late twenties reports a sudden, 3-month onset of a deepening voice, marked temporal balding, and clitoral enlargement. Laboratory workup reveals a serum total testosterone concentration of 220 ng/dL with a normal DHEA-S level.Sertoli-Leydig cell tumor
- A female university student presents with persistent cystic acne and menstrual irregularity dating back to menarche. Her basal morning 17-hydroxyprogesterone is elevated, and administration of synthetic ACTH results in a pronounced further increase.Nonclassic congenital adrenal hyperplasia
- A middle-aged female is referred due to the sudden onset of severe hirsutism, male-pattern hair loss, and central adiposity over a 4-month period. Laboratory testing demonstrates a significantly elevated DHEA-S level exceeding 800 µg/dL.Adrenocortical carcinoma
Cevap
The correct matches align gradual ovarian hyperandrogenism to Polycystic ovary syndrome; rapid, extreme ovarian virilization to Sertoli-Leydig cell tumor; ACTH-responsive hyperandrogenism to Nonclassic congenital adrenal hyperplasia; and rapid, extreme adrenal virilization to Adrenocortical carcinoma.
The differential diagnosis of female hyperandrogenism is categorized by the organ of origin (ovary vs. adrenal) and the underlying mechanism (functional vs. neoplastic). Gradual hyperandrogenism without frank virilization usually points to functional disorders. Polycystic ovary syndrome features mild testosterone elevations. Nonclassic congenital adrenal hyperplasia mimics this but is identified by elevated 17-hydroxyprogesterone. Conversely, rapid-onset virilization indicates a tumor. Ovarian tumors (Sertoli-Leydig) secrete pure testosterone, while adrenal tumors (Adrenocortical carcinoma) secrete large amounts of DHEA-S.
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Anahtar Kavram
Formulating a differential diagnosis for hyperandrogenism requires distinguishing between ovarian and adrenal sources utilizing chronicity, testosterone levels, DHEA-S, and 17-hydroxyprogesterone testing.
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