Women may seek help for PCOS for any number of reasons. They may become fed up with unwanted hair growth, have problems conceiving or have irregular periods. If this sounds like you, the best thing you can do is to document any symptoms that you may be concerned about and find a doctor whom you trust to discuss them with. Keep track of your periods: how frequently you get them and how long they last. Note any abnormal hair growth, or weight loss difficulties. It is very important to keep track of everything as the doctor will need that information when considering the differential diagnosis of PCOS, or the other conditions which may cause your symptoms. Finally, be honest. There’s no need to be embarrassed when speaking with your doctor as any information that you hold back may cause the doctor to make an improper diagnosis.
Whatever it is that brings you in to see the doctor, it may take some time before a diagnosis is reached. The doctor may ask a lot of questions or have some diagnostic tests performed before making any conclusions, including PCOS (polycystic ovary syndrome). The purpose of this is to analyze all of the information available to him so that he may offer the best treatment possible. The following are some of the diseases included in the differential diagnosis of PCOS.
Thyroid Disease
The thyroid gland is a small gland located in the front of the throat that regulates much of the body’s metabolism. It produces two hormones, triiodothyronine (known as T3), and thyroxine (known as T4) in response to a third hormone, thyroid stimulating hormone or TSH, which is produced by the pituitary gland in the brain. These hormones (T3 and T4) are released into the circulation either free, or bound to a protein known as thyroxine-binding globulin (TBG). Free thyroid hormones are considered to be the active form of the hormone, whereas the bound hormones act as a reservoir and generally are not considered to be active.Because of the effect on the body’s metabolism and other hormones, many of the symptoms of thyroid disease are similar to PCOS. When too much thyroid hormone is produced - a condition known as hyperthyroidism -- a woman may experience irregular periods, abnormal and temporary hair loss, heat intolerance, weight loss or other symptoms. If too little thyroid hormone is produced, known as hypothyroidism, symptoms include absent or infrequent periods, weight gain, fatigue and cold intolerance. The doctor will want to measure the amount of thyroid hormones in the blood to determine if an imbalance in those hormones could be behind the symptoms you are experiencing.
For more information:
Thyroid Disease
Hyperprolactinemia
Prolactin is a hormone produced by the pituitary gland, a tiny gland located in the brain. Normally found in pregnant or nursing women, it acts on the mammary glands to assist in lactation. When inappropriately produced (as in non-nursing women), it can cause irregular periods and milk production (galactorrhea). While there are some pituitary tumors that can cause increased production of prolactin, there are other things that can also cause hyperprolactinemia. Breast stimulation, intercourse, and certain medications can all be to blame. There is a simple blood test that can be performed to evaluate the level of prolactin in the blood. If it comes back high, your doctor may order an MRI (Magnetic Resonance Imaging) to rule out a pituitary tumor as the cause of the elevated test. Also, PCOS itself can cause mild increases in prolactin.For more information:
Hyperprolactinemia
Congenital Adrenal Hyperplasia
This disorder occurs when the adrenal glands -- small glands located on top of the kidneys -- do not produce enough cortisol and aldosterone, but produce too much androgens. Cortisol is the body’s main stress hormone, helping the tissues and organs cope during times of stress. Aldosterone helps to regulate the concentration of sodium and other electrolytes in the body. Women born with this disease may experience irregular periods, excessive hair growth, and failure to menstruate. While this disease is typically diagnosed in early childhood, doctors must make sure that these hormones are in balance when evaluating someone for PCOS. In addition to genetic tests that can detect this, your doctor may order urine and blood tests to detect levels of aldosterone and cortisol.For more information:
Late Onset Congenital Adrenal Hyperplasia
Cushing Syndrome
Cushing’s Syndrome is a disease where there is an overproduction of adrenal hormones. This could be caused by a few different things, including a tumor on the adrenal glands which produces too much cortisol, or other hormonal imbalances which may affect secretion of adrenocorticotropic hormone (ACTH). ACTH stimulates cells of the adrenal glands to produce adrenal hormones. Adrenal hormones are responsible for a variety of functions within the body, including carbohydrate metabolism, electrolyte regulation, and management of stress on the body. Patients with this syndrome may have higher then normal levels of androgens, contributing to many of the same symptoms of PCOS. Additionally, patients may notice weight gain, a round and full face, increased urination, or skin changes. Your doctor may order urine or blood tests to measure the amount of adrenal hormones present.For more information:
Cushings Syndrome
Sources:
Jensen, Jani R. and Ruben Alvero. "Polycystic Ovarian Syndrome." Reproductive Endocrinology and Infertility: The Requisites in Obstetrics and Gynecology. Ed. Mark Evans, MD. Philadelphia: Mosby, 2007. 65-75.
Pagana, Kathleen Deska and Timothy J. Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. Second Edition. St. Louis: Mosby, 2002.
