Causes, Patterns, and Severity of Androgen Excess in 1205 Consecutively Recruited Women

被引:50
作者
Elhassan, Yasir S. [1 ,2 ]
Idkowiak, Jan [1 ,2 ]
Smith, Karen [3 ]
Asia, Miriam [2 ]
Gleeson, Helena [2 ]
Webster, Rachel [3 ]
Arlt, Wiebke [1 ,2 ]
O'Reilly, Michael W. [1 ,2 ]
机构
[1] Univ Birmingham, Inst Metab & Syst Res, Birmingham B15 2TT, W Midlands, England
[2] Birmingham Hlth Partners, Ctr Endocrinol Diabet & Metab, Birmingham B15 2TT, W Midlands, England
[3] Univ Hosp Birmingham NHS Fdn Trust, Dept Clin Biochem, Birmingham B15 2GW, W Midlands, England
基金
英国惠康基金;
关键词
POLYCYSTIC-OVARY-SYNDROME; CONGENITAL ADRENAL-HYPERPLASIA; 11-OXYGENATED C19 STEROIDS; 21-HYDROXYLASE DEFICIENCY; METABOLIC PHENOTYPE; POSITION STATEMENT; MASS-SPECTROMETRY; PREVALENCE; HYPERANDROGENISM; HIRSUTISM;
D O I
10.1210/jc.2017-02426
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 cutoffs 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 center between 2012 and 2016. Serum A4 and T were measured by tandem mass spectrometry and 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 (ACC) cases (n = 15) and T in all ovarian hyperthecosis (OHT) cases (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 and 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.
引用
收藏
页码:1214 / 1223
页数:10
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