Differential Diagnosis and Evaluation of Hyperandrogenism

Androgen excess or hyperandrogenism is one of the most common reproductive endocrinologic defects in women, affecting 5–10% of the reproductive-aged female population. The most common cause of hyperandrogenism is the polycystic ovary syndrome (PCOS), with nonclassic adrenal hyperplasia (NCAH), androgen-secreting tumors, and androgenic drug intake being much less frequent. Hyperandrogenism, the endocrine disorder, should be distinguished from dermatological disorders such as hirsutism, although there is significant overlap. Hirsutism affects approx 6–7% of reproductive-aged women in the United States, and is a common manifestation of androgen excess (Table 1). Nonetheless, hyperandrogenism may present without obvious peripheral manifestations, as in the PCOS patient of Asian extraction with little or absent hirsutism. Alternatively, not all hirsute patients have evidence of detectable androgen excess or endocrine imbalance, as in patients with “idiopathic hirsutism.” Finally, androgen excess can also be suspected in those women with other peripheral hyper-androgenic signs, including acne, excessive oiliness or seborrhea, and alopecia. Here, we briefly review the differential diagnosis of androgen excess and denote the diagnostic scheme used for the evaluation of these patients.