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Adult Hyperandrogenaemia Differential Diagnosis

Step-wise approach (PCOS, late-onset CAH, ovarian/adrenal tumour, Cushing) in adult women with elevated androgens.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Adult Hyperandrogenaemia Differential Diagnosis?

Hyperandrogenaemia in adult women is biochemical evidence of elevated androgens (testosterone, free testosterone, DHEAS, androstenedione) and clinical features of hirsutism, acne, alopecia and oligo-/anovulation.

Differential diagnosis includes polycystic ovary syndrome (most common), late-onset congenital adrenal hyperplasia (21-hydroxylase deficiency), androgen-secreting ovarian or adrenal tumour, Cushing syndrome, hyperprolactinaemia, thyroid disease and idiopathic hirsutism.

Stepwise workup uses morning testosterone, DHEAS, 17-hydroxyprogesterone, prolactin, TSH, ACTH stimulation test for CAH, dexamethasone suppression for Cushing, and ovarian/adrenal imaging when androgens are markedly elevated or rapidly progressive.

Symptoms

Hirsutism with Ferriman-Gallwey score >8
Acne and seborrhoea
Androgenic alopecia
Oligomenorrhoea or amenorrhoea
Virilisation (clitoromegaly, voice deepening) suggests tumour
Obesity and insulin resistance (PCOS)
Cushingoid features (purple striae, central obesity)

Risk Factors

Family history of PCOS or CAH
Insulin resistance and metabolic syndrome
Mediterranean and Ashkenazi ethnic background (CAH)
Ovarian or adrenal tumour history
Glucocorticoid or anabolic steroid use
Pituitary or adrenal Cushing
Hyperprolactinaemia and thyroid disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Rapid-onset hirsutism or virilisation
  • Voice deepening or clitoromegaly
  • Markedly elevated testosterone or DHEAS
  • Cushingoid features and proximal weakness

Treatment Methods

01
Hormonal panel and 17-OH-progesterone (early follicular)
02
ACTH stimulation test for late-onset CAH
03
Dexamethasone suppression for suspected Cushing
04
Ovarian/adrenal imaging for high or rapid androgens
05
Lifestyle modification, combined OCP and antiandrogen for PCOS
06
Glucocorticoid replacement for CAH
07
Surgical resection of androgen-secreting tumours

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.