I have only my own experience to offer, but here's my two cents:I have LOCAH and ovarian cysts. They resolve quickly and don't require surgery. I might never have known about them, but I had a CT scan a while back for something else and the doctor noticed them. His thought was PCOS until he looked at my history.
I was diagnosed LOCAH at 24. I had symptoms at least from my early teens, but I had no medical insurance in my early adulthood. I don't remember my initial stim test number, but I'm a mild case, which is how I reached adulthood without knowing I had this. Like you, I had symptoms of adrenal crisis that PCOS doesn't explain. I also had facial hair, some body hair, acne, fatigue (and disordered sleep). Abdominal fat. No periods for months at a time during my early 20s.
I also had an off-the-charts libido and aggressive temperament that my parents chalked up to "behavior issues." When I told them what I'd finally been diagnosed with, my mother didn't believe me and tried to push all kinds of literature at me about PCOS. I now believe that she knew for years what I had but didn't want to admit it.
So, in answer to your questions, it's possible to have LOCAH and ovarian cysts, but those aren't necessarily PCOS. The symptoms of LOCAH and PCOS are very similar and I don't know how common it is to have both.
How do you handle heat? I have an awful time in hot weather. Lots and lots of water and salt. I get crimson-faced after a few minutes of heavy exercise, and I'm in good shape (confirmed by stress test). People at the gym ask me if I'm OK all the time. I'm not a doctor, but my amateur research suggests that this points to LOCAH and not PCOS.
I'm on birth control as well and it helps all my symptoms except the sleep disorder. I take something else for that. I've also learned to live with regular waxing.
Hope this helps.
