Because the symptoms ofpolycystic ovary syndrome(PCOS) can mimic those of other conditions, and because no one test can confirm it,diagnosing PCOSrequires a differential diagnosis.
This article reviews the course of establishing a differential diagnosis for PCOS, which includes investigating thyroid disease, hyperprolactinemia, congenital adrenal hyperplasia, and Cushing’s syndrome.
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Thyroid Disease
The thyroid gland is a small organ located at the front of the throat that regulates much of the body’s metabolism. It produces two hormones, known as T3 and T4, which are vital to regulating many key bodily functions including respiration, heart rate, body weight, muscle strength, and menstrual cycles.
When there is either too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism), these functions can be thrown into chaos, leading to symptoms that are strikingly similar to PCOS. These can include abnormal menstrual cycles, unexplained changes in weight, fatigue, temperature intolerance, and, in the case of hypothyroidism, infertility.
Hyperprolactinemia
One of the more common causes of hyperprolactinemia is a pituitary tumor called a prolactinoma. A prolactinoma can either be large or small and is most often benign (noncancerous). Hyperprolactinemia also requires a differential diagnosis to exclude thyroid disease as a cause. A magnetic resonance imaging (MRI) test can be used to confirm the presence of a tumor.
Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia (CAH) is a genetic disorder that causes the adrenal glands to produce too little cortisol and aldosterone. Cortisol is the body’s main stress hormone, while aldosterone helps regulate the level of sodium and other electrolytes in the body. At the same time, CAH can trigger the excessive production of androgens, the hormones associated with male characteristics.
These imbalances can lead women to experience irregular periods, excessive hair growth (hirsutism), and the failure to menstruate (amenorrhea). Unlike PCOS, CAH can be diagnosed with a genetic test.
Cushing’s Syndrome
As with PCOS, there is no single test to confirm a Cushing’s diagnosis. Typically, urine and saliva tests are performed to measure and evaluate the pattern of cortisol production consistent with Cushing’s syndrome.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Singla R, Gupta Y, Khemani M, Aggarwal S.Thyroid disorders and polycystic ovary syndrome: An emerging relationship.Indian J Endocrinol Metab. 2015;19(1):25–29. doi:10.4103/2230-8210.146860Meek CL, Bravis V, Don A, Kaplan F.Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism.The Obstetrician & Gynaecologist. 2013;15(3):171-176. doi:10.1111/tog.12030Delcour C, Robin G, Young J, Dewailly D.PCOS and Hyperprolactinemia: what do we know in 2019?Clinical Medicine Insights: Reproductive Health. 2019;13:117955811987192. doi:10.1177/1179558119871921Brzana J, Yedinak CG, Hameed N, Plesiu A, Mccartney S, Fleseriu M.Polycystic ovarian syndrome and Cushing’s syndrome: a persistent diagnostic quandary.European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:145-148. doi:10.1016/j.ejogrb.2013.12.038Additional ReadingWilliam, T.; Mortada, R.; and Porter, S. “Diagnosis and Treatment of Polycystic Ovary Syndrome.“Amer Fam Phys.2016; 94(2):106-13. PMID:27419327.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Singla R, Gupta Y, Khemani M, Aggarwal S.Thyroid disorders and polycystic ovary syndrome: An emerging relationship.Indian J Endocrinol Metab. 2015;19(1):25–29. doi:10.4103/2230-8210.146860Meek CL, Bravis V, Don A, Kaplan F.Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism.The Obstetrician & Gynaecologist. 2013;15(3):171-176. doi:10.1111/tog.12030Delcour C, Robin G, Young J, Dewailly D.PCOS and Hyperprolactinemia: what do we know in 2019?Clinical Medicine Insights: Reproductive Health. 2019;13:117955811987192. doi:10.1177/1179558119871921Brzana J, Yedinak CG, Hameed N, Plesiu A, Mccartney S, Fleseriu M.Polycystic ovarian syndrome and Cushing’s syndrome: a persistent diagnostic quandary.European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:145-148. doi:10.1016/j.ejogrb.2013.12.038Additional ReadingWilliam, T.; Mortada, R.; and Porter, S. “Diagnosis and Treatment of Polycystic Ovary Syndrome.“Amer Fam Phys.2016; 94(2):106-13. PMID:27419327.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Singla R, Gupta Y, Khemani M, Aggarwal S.Thyroid disorders and polycystic ovary syndrome: An emerging relationship.Indian J Endocrinol Metab. 2015;19(1):25–29. doi:10.4103/2230-8210.146860Meek CL, Bravis V, Don A, Kaplan F.Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism.The Obstetrician & Gynaecologist. 2013;15(3):171-176. doi:10.1111/tog.12030Delcour C, Robin G, Young J, Dewailly D.PCOS and Hyperprolactinemia: what do we know in 2019?Clinical Medicine Insights: Reproductive Health. 2019;13:117955811987192. doi:10.1177/1179558119871921Brzana J, Yedinak CG, Hameed N, Plesiu A, Mccartney S, Fleseriu M.Polycystic ovarian syndrome and Cushing’s syndrome: a persistent diagnostic quandary.European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:145-148. doi:10.1016/j.ejogrb.2013.12.038
Singla R, Gupta Y, Khemani M, Aggarwal S.Thyroid disorders and polycystic ovary syndrome: An emerging relationship.Indian J Endocrinol Metab. 2015;19(1):25–29. doi:10.4103/2230-8210.146860
Meek CL, Bravis V, Don A, Kaplan F.Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism.The Obstetrician & Gynaecologist. 2013;15(3):171-176. doi:10.1111/tog.12030
Delcour C, Robin G, Young J, Dewailly D.PCOS and Hyperprolactinemia: what do we know in 2019?Clinical Medicine Insights: Reproductive Health. 2019;13:117955811987192. doi:10.1177/1179558119871921
Brzana J, Yedinak CG, Hameed N, Plesiu A, Mccartney S, Fleseriu M.Polycystic ovarian syndrome and Cushing’s syndrome: a persistent diagnostic quandary.European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;175:145-148. doi:10.1016/j.ejogrb.2013.12.038
William, T.; Mortada, R.; and Porter, S. “Diagnosis and Treatment of Polycystic Ovary Syndrome.“Amer Fam Phys.2016; 94(2):106-13. PMID:27419327.
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