Polycystic ovary syndrome laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Measurement of the plasma levels of several hormones is helpful in supporting the diagnosis of PCOS and specially in excluding other disorders. Determining the LH/FSH ratio of 3:1 is virtually diagnostic of PCOS. However, a normal ratio does not exclude the diagnosis, as LH levels fluctuate widely throughout the course of a day. Other androgens are measured to screen for other virilizing adrenal tumors. Fasting blood glucose is measured to look for diabetes, screening for lipid abnormalities is also employed. Testosterone is measured to exclude a virilizing tumor. Prolactin is measured to exclude a prolactinoma. Thyroid-stimulating hormone (TSH) is measured to rule out hypothyroidism.
Laboratory Findings
Measurement of the plasma levels of several hormones is helpful in supporting the diagnosis of PCOS and specially in excluding other disorders. Determining the LH/FSH ratio of 3:1 is virtually diagnostic of PCOS. However, a normal ratio does not exclude the diagnosis, as LH levels fluctuate widely throughout the course of a day. Other androgens are measured to screen for other virilizing adrenal tumors. Fasting blood glucose is measured to look for diabetes, screening for lipid abnormalities is also employed. Testosterone is measured to exclude a virilizing tumor. Prolactin is measured to exclude a prolactinoma. Thyroid-stimulating hormone (TSH) is measured to rule out hypothyroidism.[1][2][3][4]
| Harmone | Normal value | PCOS Laboratory Findings | |
|---|---|---|---|
| LH/FSH ratio | <3;1 | A ratio >3:1 is indicative of PCOS | |
| Testosterone | Free: 100 to 200 pg/dL
Total: 20 to 80 ng/dL |
An elevated free testosterone level (200-400 pg/dL) is suggestive of PCOS, | |
| Prolactin | 3.8 to 23.2 μg/L | A level >300 μg/L is virtually diagnostic of prolactinoma. | |
| TSH | 0.4 to 4.2 mIU/L | Levels are normal in patients with PCOS | |
| Androgens | Sex hormone–binding globulin | 1.5 to 2.0 μg/mL | Decreased |
| Androstenedione | 75 to 205 ng/dL | Increased | |
| Estrone | 1.5 to 25.0 pg/mL | Increased | |
| Dehydroepiandrosterone sulfate | 50 to 450 μg/dL | Increased but are <800 μg/dL | |
| 17-Hydroxyprogesterone | 15 to 70 ng/dL | Normal | |
| Fasting blood glucose | <110 mg/dL | >126mg/dL Indicates DM | |
Approach to hyperandrogenism
| Signs of hyperandrogenism hirsutism, alopecia, masculine appearance, acne | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| History of drug use | Presence of oligomenorrhea | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ Stop using the drug ❑ PCOS ruled out | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Perform an ultrsound of pelvis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal morphology of ovaries | Cystic morphology of ovaries | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ PCOS is ruled out ❑ Look for adrenal tumors, ovarian tumors | Measure testosterone levels | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ Elevated 17-hydroxyprogesterone/[DHEAs]: CAH, adrenal tumors ❑ Elevated cortisol: Cushings syndrome, cortisol resistance ❑ Prolactin,TSH,IGF1 abnormal: Hyperprolactinoma, thyroid dysfunction acromegaly | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Normal | Elevated | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Risk factors of Hirsutism present? | PCOS | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PCOS ruled out | Hirsutism present? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mild hirsutism | Severe Hirsutism | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PCOS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Trial of OCP | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ❑ Positive response | ❑ Negative: worsening of symptoms | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Idiopathic hirsutism | PCOS | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Banaszewska B, Spaczyński RZ, Pelesz M, Pawelczyk L (2003). "Incidence of elevated LH/FSH ratio in polycystic ovary syndrome women with normo- and hyperinsulinemia". Rocz. Akad. Med. Bialymst. 48: 131–4. PMID 14737959.
- ↑ Sirmans SM, Pate KA (2013). "Epidemiology, diagnosis, and management of polycystic ovary syndrome". Clin Epidemiol. 6: 1–13. doi:10.2147/CLEP.S37559. PMC 3872139. PMID 24379699.
- ↑ Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E (2015). "AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME--PART 1". Endocr Pract. 21 (11): 1291–300. doi:10.4158/EP15748.DSC. PMID 26509855.
- ↑ Mihailidis J, Dermesropian R, Taxel P, Luthra P, Grant-Kels JM (2017). "Endocrine evaluation of hirsutism". Int J Womens Dermatol. 3 (1 Suppl): S6–S10. doi:10.1016/j.ijwd.2017.02.007. PMC 5419053. PMID 28492032.