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{{familytree | | | C01 | | | | | | | | |!| |C01=Stop using the drug<br> [[PCOS]] ruled out}}
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Revision as of 20:10, 1 November 2017

Polycystic ovary syndrome Microchapters

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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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
17-hydroxyprogesterone/[DHEAs]elevated =CAH,adrenal tumors
cortisol elevated=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

  1. 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.
  2. 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.
  3. 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.
  4. 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.

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