The diagnosis of polycystic ovaries in women with oligo‐amenorrhoea: predictive power of endocrine tests

Abstract

The ability of several endocrine tests to distinguish between women with and without polycystic ovaries (PCO) has been studied prospectively in a series of 65 patients with functional oligo-amenorrhoea using ultrasonography as a reference test. In terms of overall diagnostic accuracy, the free androgen index (FAI) (94%) and the progestogen challenge (89%) gave similar results (Cl = -5 to 15%) but both were significantly better than all the other tests including measurement of serum LH (69%), total testosterone (71%) and androstenedione (74%) (minimum Cl = 6 to 23%). The FAI together with LH measurement was the most accurate of the combinations (97%) but this was not significantly better than the best of the combinations incorporating the progestogen challenge (92%; Cl = -3% to 13%). Given the limited availability of the assay for SHBG, these results show that assessment of oestrogen state is a useful method for categorizing patients with functional oligo-amenorrhoea.

Diagnosis of Polycystic Ovary Syndrome

“…(12) In contrast, the diagnosis of the PCOS is based on both clinical and biochemical criteria. (13)(14)(15) PCOS can be expressed in a way of wide variety of clinical features since the definition of the syndrome has been rather vague. Thus, the criteria for diagnosis of PCOS used by clinicians and investigators are almost as heterogeneous as the syndrome itself.…”

Measurement of serum testosterone in women; what should we do?

“…The reasons for this are still unclear for most assays but certainly include inaccurate calibration in addition to the e¡ect of interfering Ann Clin Biochem 2007; 44: [5][6][7][8][9][10][11][12][13][14][15] substances. The degree of interference is not predictable in any given sample adding to the complexity of interpretation of the results.…”

“…This could potentially result in normal women having results suggestive of polycystic ovarian syndrome or a more serious condition such Ann Clin Biochem 2007; 44: [5][6][7][8][9][10][11][12][13][14][15] as an androgen-secreting tumour or late onset congenital adrenal hyperplasia. This could in turn potentially lead to unnecessary further investigations or procedures being performed on these patients.…”

“…Many laboratories also calculate the Free Androgen Index (serum testosterone Â100/SHBG) (FAI). This has been shown in some studies to be a more sensitive marker of PCOS, 5,6 although its accuracy in predicting free testosterone concentration has been questioned. 7 Measurements of free testosterone have been performed using equilibrium dialysis techniques but, being technically complex, these are not suitable for use in most laboratories.…”

“…Networks of steroid reference laboratories also exist 15 whose members exchange protocols and results so as to maintain a trueness base (established using a panel of unprocessed single donation human sera whose testosterone values have been assigned by the reference laboratories). The newly formed Joint Committee for Traceability in Laboratory Medicine (JCTLM) 16 is compiling a database of reference methods and reference materials, which can be used to assign values to calibrants and controls Ann Clin Biochem 2007; 44: [5][6][7][8][9][10][11][12][13][14][15] and thus meet the traceability requirements of the European Union In Vitro Diagnostic Devices (EU IVD) Directive. 17 Materials and methods for steroid hormones were among the ¢rst to be included in the JCTLM database.…”