Although no agreed-upon diagnostic criteria currently exist for adolescent polycystic ovarian syndrome (PCOS), hyperandrogenemia is essential for the diagnosis in this age group
All conditions that mimic PCOS should be ruled out before a diagnosis of PCOS is confirmed. Consider the following in the differential diagnosis of PCOS:
Ovarian hyperthecosis
Congenital adrenal hyperplasia (late-onset)
Drugs (eg, danazol, androgenic progestins)
Hypothyroidism
Patients with menstrual disturbances and signs of hyperandrogenism
Idiopathic hirsutism
Familial hirsutism
Masculinizing tumors of the adrenal gland or ovary (rapid onset of signs of virilization)
Cushing syndrome (low K+, striae, central obesity, high cortisol; high androgens in adrenal carcinoma)
Hyperprolactinemia
Exogenous anabolic steroid use
Stromal hyperthecosis (valproic acid)
Differential Diagnoses
3-Beta-Hydroxysteroid Dehydrogenase Deficiency
Acromegaly
Adrenal Carcinoma Imaging
Amenorrhea
Congenital Adrenal Hyperplasia
Gigantism and Acromegaly
Hyperprolactinemia
Hyperthyroidism and Thyrotoxicosis
Hypothyroidism
Iatrogenic Cushing Syndrome
Ovarian Tumors