What is the most likely diagnosis?

A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.

Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18C25) and a blood pressure of 140/90 mmHg.

The following results were obtained within 1 week of her last menstrual period.

Investigations:

overnight dexamethasone suppression test (after 1 mg dexamethasone):

serum cortisol30 nmol/L (<50)

serum dehydroepiandrosterone sulphate12 µmol/L (3C12)

serum androstenedione10.0 nmol/L (0.6C8.8)

serum 17-hydroxyprogesterone38 nmol/L (1C10)

serum oestradiol200 pmol/L (200C400)

serum testosterone3.5 nmol/L (0.5C3.0)

serum sex hormone binding globulin30 nmol/L (40C137)

plasma follicle-stimulating hormone4.0 U/L (2.5C10.0)

plasma luteinising hormone6.0 U/L (2.5C10.0)

What is the most likely diagnosis?
A . adrenal androgen-secreting tumour
B . Cushing’s syndrome
C . late-onset congenital adrenal hyperplasia
D . ovarian androgen-secreting tumour
E . polycystic ovary syndrome

View Answer

Answer: C