Aims: To discover if the addition of DHEAS (dehydroepiandrosterone sulphate) and androstenedione aids diagnosis in GP patients with PCOS (polycystic ovary syndrome) as part of their differential diagnosis.
Methods: Over two months our laboratory received seventy-nine female General Practice patients whose symptoms / signs led to a differential diagnosis including PCOS. Of these, nine had a raised total testosterone and twenty-seven had a raised free androgen index (FAI) (18 with a normal total testosterone). Forty-four patients who had a normal total testosterone and FAI (if calculated) were selected from the seventy-nine and had androstenedione and DHEAS measured. Normally female samples with a testosterone greater than 1.5nmol/L (reference range 0.5 - 2.6nmol/L) are cascaded for SHBG (sex hormone binding globulin) measurement and subsequent FAI calculation (FAI = total testosterone / SHBG*100). SHBG was measured, if this test had not been cascaded, and the FAI calculated. Testosterone was measured using the Ciba-Corning ACS:180 Plus; DHEAS and SHBG were measured using the DPC:Immulite 2000 and androstenedione was measured using the DPC: Coat-a-count method.
Results: Eight patients had an androstenedione level above the reference range; seven of which had androstenedione as the only raised androgen. One patient was found to have a raised FAI due to low SHBG, despite having a testosterone <1.5nmol/L, and one patient had a raised DHEAS.
Conclusion: Androstenedione was raised in 18% of the forty-four cases, much higher than predicted, and was almost always raised alone. From the original cohort of seventy-nine, thirty-six (46%) had at least one abnormal androgen result. This suggests that when PCOS is suspected and total testosterone and / or FAI is normal, androstenedione should be measured. This is particularly important when GP's adhere to a protocol where a patient is only referred for further investigation (ultrasound) if they have an abnormal androgen result.