Background and Aims: Clinical management of women with hyperandrogenic symptoms varies widely and UK guidelines are lacking. Dependent on presentation, differential diagnoses may include thyroid dysfunction, hyperprolactinaemia, congenital adrenal hyperplasia (CAH), hypercortisolism, acromegaly and pregnancy. Women presenting with hyperandrogenic symptoms can have a normal or elevated testosterone. This study describes hormone requesting relevant to these conditions in women with newly elevated testosterone concentrations.
Method: Women, 18-45 years old, with a serum testosterone (TEST) >1.7 nmol/L were identified from laboratory databases for a one year period beginning 01/06/2015. Exclusion criteria were: elevated TEST in previous year, an elevated human chorionic gonadotrophin at baseline; known CAH; or known transgender patient. Follow-up period was 6 months. Frequency of requesting for thyroid stimulating hormone (TSH), prolactin (PRL), 17-hydroxyprogesterone (17OHP), anti-Müllerian hormone (AMH), urine cortisol (UCORT), and insulin-like growth factor 1 (IGF1) were described.
Results: For 368 women, frequency of baseline requesting was as follows: TSH=73%; PRL=52%; 17OHP=1.6%; AMH=22%; IGF1=0.5%. Percentage abnormal results (results outside the reference interval or above clinical cut-offs) were: TSH=8%; PRL=19%; AMH=59%. Combined frequencies of tests at baseline and during follow up were: TSH=78%; PRL=55%; 17OHP=6%; AMH=26%; IGF1=0.5%; UCORT=1.1%. Combined frequencies of abnormal results at baseline and during follow up were: TSH=8%; PRL=19%; AMH=59%; UCORT=25%. TEST requests were repeated in 10% of women, 61% of which remained elevated.
Conclusion: Results show wide variation in the extent of investigation of hyperandrogenism, suggesting variation in knowledge of key diagnostic criteria and the rigour with which differential diagnoses are sought. Additional tests are not often requested in the follow up of an elevated testosterone. An exception is 17OHP, with 8% of subjects tested in the follow-up period, compared with 1% at baseline. Further work is required to correlate requesting patterns with degree of TEST elevation and describe patterns in women with normal baseline TEST.