Differential Diagnoses 

 

 

1. Thyroid Dysfunction – Hypothyroidism is the most common thyroid disorder and is the result of decreased production of thyroid hormone (TH) and increased release of thyroid stimulating hormone (TSH). Some symptoms of hypothyroidism include weight gain and menstrual irregularity. Although Barbie was experiencing unwanted weight gain of 15 pounds and irregular periods, Barbie’s TSH was normal indicating normal thyroid function (McCance & Huether, 2019, p. 680).

 

2. Hyperprolactinemia—Hyperprolactinemia is caused by elevated levels of prolactin and is a normal process after childbirth to help aid in lactation and breastfeeding. Elevated levels of prolactin are seen in patients who are NOT pregnant is considered an irregular finding and can be a cause of irregular menses. High levels of prolactin can cause irregular menstruation, acne, and facial hair which are symptoms Barbie is experiencing. However, when evaluating Barbie’s lab work, a normal level of prolactin was found which would tell a practitioner that Hyperprolactinemia is not the cause of her symptoms (McCance & Huether, 2019, p. 760-761).

 

3. Congenital Adrenal Hyperplasia – CAH is an autosomal recessive disorder which causes a decreased amount of the enzyme necessary to create cortisol (McCance & Huether, 2019). Since the cortisol level is decreased, higher levels of adrenocorticotropic hormone (ACTH) will be present which leads to adrenal gland enlargement and increased androgen production. Females with higher androgen level may exhibit excess facial hair, weight gain, and menstrual irregularity which is clinically seen with Barbie. According to Rackow, Lobo, and Lentz (2017), CAH may be seen upon birth by the clinical presentation of ambiguous genitals or it may not be seen until later in life. An elevated 17-hydroxyprogesterone would be indicative of potential CAH. However, Barbie’s 17-hydroxyprogesterone was normal.