Recommendations for investigation of hyperandrogenism - 24/02/10

Doi : 10.1016/j.ando.2009.12.007

M. Pugeat ^a,^⁎ , H. Déchaud ^b, V. Raverot ^b, A. Denuzière ^c, R. Cohen ^b, P. Boudou ^d
^a Inserm U863 IFR6, fédération d’endocrinologie, groupement hospitalier Est, hospices civils de Lyon, université Lyon-1, 59, boulevard Pinel, bâtiment Aile-A1, 69677 Bron cedex, France
^b Inserm U863 IFR62, laboratoire de radio-analyse, groupement hospitalier Est, hospices civils de Lyon, université Lyon-1, 69677 Bron cedex, France
^c Laboratoire de biologie endocrinienne, oncologie et du métabolisme osseux, hôpital Edouard-Herriot, hospices civils de Lyon, université Lyon-1, 5, place d’Arsonval, 69437 Lyon cedex 03, France
^d Unité de transfert en oncologie moléculaire et hormonologie, Saint-Louis, Paris 1, avenue Claude-Vellefaux, 75010 Paris, France

^⁎Corresponding author.

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Abstract

1. Total testosterone assay is recommended as the first-line approach.

2. Radioimmunological assay following prior treatment of the sample (extraction or extraction + chromatography) is the recommended method pending wider experience with mass spectrometry.

3. Where testosterone is twice the upper limit of normal, it is recommended that DHEAS assay be performed. DHEAS is primarily of cortico-adrenal origin in women. Thus, a DHEAS level over 600 mg/dl indicates a diagnosis of androgen-secreting adrenal cortical adenoma.. If DHEAS is normal, the diagnosis could be either ovarian hyperthecosis, normally associated with insulin resistance, or androgen-secreting ovarian tumour.

4. More rarely, elevated testosterone is associated with a marked elevation of SHBG possibly as the result of use of medication having an estrogenic effect (tamoxifen, raloxifene, Op’DDD), or of hyperthyroidism or liver disease.

5. Normal testosterone levels in patients with clear clinical symptoms of hyperandrogenism (hirsutism, seborrhoeic acne) must be interpreted with care. SHBG is normally reduced in the event of overweight, metabolic syndrome or familial history of diabetes.

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Keywords : Testosterone, Androgen measurement, Hyperandrogenism investigation