Causes, patterns and severity of androgen excess in 1205 consecutively recruited women.

Causes, patterns and severity of androgen excess in 1205 consecutively recruited women.

J Clin Endocrinol Metab. 2018 Jan 12;:

Authors: Elhassan YS, Idkowiak J, Smith K, Asia M, Gleeson H, Webster R, Arlt W, O'Reilly MW

Abstract
Context: Androgen excess in women is predominantly due to underlying polycystic ovary syndrome (PCOS). However there is a lack of clarity regarding patterns and severity of androgen excess that should be considered predictive of non-PCOS pathology.
Objective: We examined the diagnostic utility of simultaneous measurement of serum dehydroepiandrosterone sulfate (DHEAS), androstenedione (A4) and testosterone (T) to delineate biochemical signatures and cut-offs predictive of non-PCOS disorders in women with androgen excess.
Design: Retrospective review of all women undergoing serum androgen measurement at a large tertiary referral centre between 2012 and 2016. Serum A4 and T were measured by tandem mass spectrometry, DHEAS by immunoassay. Patients with at least one increased serum androgen underwent phenotyping by clinical notes review.
Results: In 1205 women, DHEAS, A4, and T were measured simultaneously. PCOS was the most common diagnosis in premenopausal (89%) and postmenopausal women (29%). A4 was increased in all adrenocortical carcinoma cases (ACC; n=15) and T in all ovarian hyperthecosis cases (OHT; n=7); all but one case of congenital adrenal hyperplasia (CAH; n=18) were identified by increased levels of A4 and/or T. In premenopausal women, CAH was a prevalent cause of severe A4 (59%) and T (43%) excess; severe DHEAS excess was predominantly due to PCOS (80%). In postmenopausal women, all cases of severe DHEAS and A4 excess were caused by ACC, severe T excess equally by ACC and OHT.
Conclusions: Pattern and severity of androgen excess are important predictors of non-PCOS pathology and may be used to guide further investigations as appropriate.

PMID: 29342266 [PubMed - as supplied by publisher]

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