Recommendations for investigation of hyperandrogenism

Pugeat, Michel; Déchaud, H.; Raverot, Véronique; Denuzière, Anne; Cohen, Richard A.; Boudou, Philippe

doi:10.1016/j.ando.2009.12.007

Cited by 26 publications

(14 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Measurement of DHEAS, a hormone of predominantly adrenal origin in women, is not routinely required, although when a neoplastic source of androgen excess is suspected a very high DHEAS concentration may be predictive of an androgen-secreting adrenal cancer (19). The evaluation of steroid hormone profiles, by using liquid chromatography combined with tandem mass spectrometry, a recent technique displaying good precision, sensitivity, and high accuracy, would greatly improve the assessment of androgen excess in patients with PCOS (20,21,22,23).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: There is evidence for differences between endocrinologists and other specialists in their approach to diagnosis and management of the polycystic ovary syndrome (PCOS). Objective: A mailed survey consisting of a simple questionnaire aiming to understand current practice for diagnosis and management of the PCOS by specialists across Europe. Methods: The questionnaire consisted of 23 questions grouped to achieve information on i) the general characteristics of the respondents, ii) patients with PCOS seen by endocrinologists, iii) the main diagnostic criteria, iv) biochemical parameters used in the differential diagnosis of hyperandrogenism, v) long-term concerns, and, finally vi) treatment choices. A total of 357 questionnaires representing 13.3% of the members of European Society of Endocrinology (ESE) were available for final analysis; 93% of the respondents were endocrinologists Results: In relation to the diagnostic criteria, respondents were most likely to select menstrual irregularity as the most frequent criteria used for the diagnosis of PCOS although very high rates were achieved for the use of hirsutism and biochemical hyperandrogenism. It therefore appears that the NIH criteria were followed by the majority of respondents. The most frequent biochemical parameters in the differential diagnosis of hyperandrogenism were total testosterone or free androgen index. Obesity and type 2 diabetes were regarded as the principal long-term concerns for PCOS. The most common treatments for patients with PCOS were metformin (33%), lifestyle modification (25%), and oral contraceptives (22%). More direct treatments of infertility include clomiphene citrate alone or in combination with metformin, prescribed by 9 and 23%, respectively, whereas only 6% used other methods for induction of ovulation.

show abstract

Section: European Journal Of Endocrinologymentioning

confidence: 99%

European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire

Conway¹,

Dewailly²,

Diamanti-Kandarakis³

et al. 2014

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…To assay testosterone, antibodies are developed that match its particular structure, at the price of their specificity, as the configuration of testosterone is similar to that of other circulating androgens. An extraction step, using an organic solvent, followed by purification of the extract by chromatography (Celite, HPLC, Sephadex LH20), eliminates steroids likely to interfere with the immunological reaction because of their similar structure and/or insufficient antibody specificity (12,13). Steroid extraction, also eliminates much of the matrix effect, mainly related to steroid transport proteins (albumin and SHBG).…”

Section: Pitfalls In Measuring Total Testosterone By Direct Immunoassaymentioning

confidence: 99%

“…This variation is due to differences between assay kits and to the lack of precision of most assay kits at these concentration levels. Scatter decreases with increasing control sample concentration, and becomes acceptable for concentrations comparable to those found in men (13). The limitations of testosterone assays were summarized in a position statement by the Endocrine Society (28), and a CDC Hormone Standardization Project has been promoted (113,114,115).…”

Section: External Quality Assessment (Eqa) Of Hormone Assaysmentioning

confidence: 99%

“…These include the 1990 NIH-sponsored conference on PCOS (2,14), the Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group (3), the Androgen Excess and PCOS Society (4), the French Endocrine Society Consensus (13), and the PCOS Special Interest Group of the European Society of Endocrinology (18).…”

Section: Hyperandrogenic States In Women: Pitfalls In Laboratory Diagmentioning

confidence: 99%

“…EQA is an audit tool that can identify the improvements required to reduce the risk of inaccurate hormone assessment that are of central importance for the diagnosis of endocrine disease (112). EQA has been undertaken in several countries, including France since 1977 by a Lyonbased association of biologists (Probioqual) (13). Participating laboratories receive lyophilized control sera 6 times per year, for assay of numerous analytes, including testosterone.…”

Section: External Quality Assessment (Eqa) Of Hormone Assaysmentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE Hyperandrogenic states in women: pitfalls in laboratory diagnosis

Pugeat

Plotton

Perrière

et al. 2018

European Journal of Endocrinology

View full text Add to dashboard Cite

Measuring total testosterone level is the first-line approach in assessing androgen excess in women.The main pitfalls in measuring testosterone relate to its low concentration and to the structural similarity between circulating androgens and testosterone, requiring accurate techniques with high specificity and sensitivity. These goals can be achieved by immunoassay using a specific antitestosterone monoclonal antibody, ideally after an extraction step. Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) will be commonly used for measuring testosterone, providing optimal accuracy with a low limit of detection. Yet, the pitfalls of these two techniques are well identified and must be recognized and systematically addressed. In general, laboratories using direct testosterone immunoassay and mass spectrometry need to operate within a quality framework and be actively engaged in external quality control processes and standardization, so as to ensure appropriate interpretation irrespective of the particular laboratory. Circulating testosterone is strongly bound to sex-hormone binding-globulin (SHBG), and SHBG levels are typically low in overweight hyperandrogenic patients. Thus, low SHBG may decrease circulating testosterone to normal values, which will mask androgen excess status. One way to avoid this pitfall, awaiting direct free-testosterone assays that are yet to be developed, is to measure SHBG and calculate free testosterone. A few other pitfalls will be discussed in this review, including those of adrenal androgen exploration, with the aim of helping clinicians to better handle laboratory investigation of androgen excess disorders in women.

show abstract