Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism

Abstract

Key content The presence of clinical or biochemical evidence of hyperandrogenism is a defining feature of polycystic ovary syndrome (PCOS). As the criteria for diagnosing PCOS becomes more inclusive, there is an increased risk of misdiagnosing women with other causes of hyperandrogenism. Biochemical testing for serum testosterone concentrations in women has important limitations. Patients with concerning features should be investigated for other causes of hyperandrogenism. Learning objectives To review the different criteria for diagnosing PCOS and the repercussions for disease prevalence. To learn about the differential diagnosis of hyperandrogenism. To learn about the limitations of biochemical testing for testosterone in women. Ethical issues Hyperandrogenism causing hirsutism and virilisation can have significant effects on physical and psychological wellbeing. Misdiagnosis can delay appropriate treatment and may affect future fertility.

The paediatrician and the management of common gynaecological conditions

“…Other causes of hyperandrogenism, including atypical congenital adrenal hyperplasia, Cushing syndrome and tumours of the adrenal gland, should be excluded if the testosterone level is >5 nmol/L,22 or 17 hydroxyprogesterone or dehydroepiandrosterone sulfate are above the upper limit of the adult reference range 18…”

Incidence of Virilisation in Sex Cord Stromal Tumours of Ovary, a 5- Year Experience in a Tertiary Care Gynaecological Centre

“…These circulating androgens are metabolised in liver, conjugated with glucuronic acids or sulphuric acids and excreted in urine as 17 ketosteroids. 4 The underlying cause of androgen excess can be assessed with detailed clinical history, age of onset, duration & severity of symptoms, physical examination & serum hormones.…”

Re: Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism

“…We studied the difference that analytical methodology can make in our own laboratory. 1 Using data from our study, a hypothetical patient who has testosterone levels at the 95 percentile and an average SHBG (median 32 nmol/L), the FAI can vary by around 3% depending upon which testosterone method is used.…”

“…1 There are a couple of things I wanted to highlight about the topic. In the biochemical assessment of hyperandrogenism, a free androgen index (FAI; the ratio of total testosterone divided by the sex hormone binding globulin multiplied by a constant) of mostly 100 is used to determine abnormal androgen status of an individual.…”