Aim: The investigation of female androgen status in our laboratory is measured as a profile. Androstenedione, testosterone and DHEAS are analysed by liquid chromatographytandem mass spectrometry. SHBG is analysed by immunoassay, and all results are reported simultaneously. The main aim was to investigate the management of patients who have a raised DHEAS level.
Method: Ethical approval was granted for this study. Females with DHEAS levels >6.9 nmol/l were selected, questionnaires were sent to the corresponding general practitioner or hospital clinician. The information gathered from the questionnaire included, signs, symptoms and prescribed medication at presentation, initial diagnosis, results of follow up investigations, final diagnosis and treatment.
Results: One hundred and seventy-four questionnaires were sent to GPs, 22% replied, the remaining data were gathered from hospital case notes for referred patients. One hundred female patients were investigated, data were analysed on 84 patients. Most patients (53%) were aged between 21 and 30 years, the commonest presenting sign was hirsuitism (43%). Eleven percent had only raised DHEAS levels. Forty-nine percentage of the patients had an USS as part of follow up, 54% were identified as having cysts on their ovaries. Eight-two percentage of the patients with cysts on their ovaries identified by USS, had a raised androstenedione level, compared to only 36% with a raised testosterone level. T-test data suggest that androstenedione and testosterone combined together can differ between those patients with a positive versus a normal USS for ovarian cysts. DHEAS and androstenedione were shown to have a significant correlation with patients age.
Conclusions: An isolated elevation of DHEAS was shown not to be clinically significant. Data suggest that age related reference ranges should be determined for androstenedione, whilst raised androstenedione and testosterone levels do relate to the presence of ovarian cysts when identified by USS.