Hirsutism laboratory findings: Difference between revisions

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==Overview==
==Overview==
It is important to carry out various biochemical tests to determine the cause of hirsutism that is necessary to make an informed decision for the best options for treatment.
Laboratory tests that should be done in hirsutism include testosterone level, DHEAS, and 24-hour cortisol level.


==Laboratory Findings==
==Laboratory Finding==
The laboratory findings
===Testosterone===
* [[Testosterone]]:
*Serum testosterone may be normal to increased in case of [[PCOS]] and [[CAH]] but would be definitely raised (>200 ng/ml) in case of [[malignant]] tumor of the [[Adrenal gland|adrenal]] or [[ovary]].<ref name="pmid18574213">{{cite journal |vauthors=Lin-Su K, Nimkarn S, New MI |title=Congenital adrenal hyperplasia in adolescents: diagnosis and management |journal=Ann. N. Y. Acad. Sci. |volume=1135 |issue= |pages=95–8 |year=2008 |pmid=18574213 |doi=10.1196/annals.1429.021 |url=}}</ref>
** The most important assay is the level of serum [[testosterone]]. If the total serum testosterone level is normal, measure the free serum level because [[hyperandrogenism]] (and [[insulin resistance]], if present) decreases sex steroid-binding globulin, such that the unbound, biologically active [[testosterone]] moiety may be elevated even if the total level is unremarkable. Extremely high testosterone levels are likely to be associated with [[Adrenal gland|adrenal]] or [[Ovarian tumor|ovarian tumors]], whereas [[idiopathic]] and [[benign]] etiologies result in very mild elevations. Indeed, in idiopathic hirsutism, the results from testing androgen levels are often normal. In some of these women, hirsutism is thought to be caused by increased skin sensitivity to androgen or by increased skin [[5-alpha-reductase]] activity.
===DHEAS===
 
*[[DHEAS|Dehydroepiandrosterone sulfate (DHEAS)]]: Raised [[DHEAS]] (>700 μg/dl) always indicates an adrenal cause, [[benign]] or [[malignant]].
* [[Dehydroepiandrosterone sulfate]] (DHEAS):  
===17-Hydroxyprogesterone===
** An elevated testosterone level does not indicate the gland of origin. Accordingly, measurement of elevated plasma levels of [[DHEAS]], an androgen synthesized almost exclusively by the [[adrenal cortex]], can indicate excess adrenal function. Elevations in both testosterone and DHEAS suggest an adrenal origin, whereas an isolated testosterone elevation indicates an [[ovarian]] source.
* [[17-Hydroxyprogesterone|17 Hydroxy progesterone]]: Levels less than 200 ng/dl excludes [[CAH]]. Mildly increased levels between 300 and 1,000 ng/dl require an [[ACTH]] stimulation test. [[Cosyntropin]] (synthetic [[ACTH]]), 250 μg, is administered intravenously, and levels of [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] are measured before and one hour after the injection. Post-stimulation values (>1,000 ng/dl) constitute a positive test.<ref name="pmid18574213">{{cite journal |vauthors=Lin-Su K, Nimkarn S, New MI |title=Congenital adrenal hyperplasia in adolescents: diagnosis and management |journal=Ann. N. Y. Acad. Sci. |volume=1135 |issue= |pages=95–8 |year=2008 |pmid=18574213 |doi=10.1196/annals.1429.021 |url=}}</ref>
* [[Dexamethasone suppression test|Dexamethasone suppression]]:
===24-hour urinary cortisol===
** [[Dexamethasone]]-mediated suppression of androgens is observed in healthy women who do not have hirsutism and in those with [[Congenital adrenal hyperplasia|congenital adrenal hyperplasia (CAH)]] and idiopathic hirsutism.
* Twenty four hour urine free [[cortisol]] should be measured in women with signs and symptoms of [[Cushing's syndrome]].
* [[Adrenocorticotropic hormone|Adrenocorticotropin]] stimulation:
===LH/FSH ratio===
** An [[Adrenocorticotropic hormone|ACTH]]-stimulation test (250 mcg for 30 min) can help differentiate between [[Congenital adrenal hyperplasia|CAH]] and idiopathic hirsutism because CAH produces abnormal findings (elevations in metabolic [[precursors]] of [[cortisol]]).
* [[LH]]/[[FSH]] greater than 3 is indicative of [[PCOS]].<ref name="pmid10352925">{{cite journal |vauthors=Chang RJ, Katz SE |title=Diagnosis of polycystic ovary syndrome |journal=Endocrinol. Metab. Clin. North Am. |volume=28 |issue=2 |pages=397–408, vii |year=1999 |pmid=10352925 |doi= |url=}}</ref>
** Hirsutism caused by [[CAH]] is due to 1 of 3 cortisol biosynthetic defects, ie, [[21-hydroxylase deficiency]], 3 3 β -hydroxysteroid dehydrogenase, or 11-β -hydroxylase deficiency.
===Serum TSH===
** [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] levels should be also obtained because [[21-hydroxylase deficiency]] is responsible for the majority of cases of [[CAH]] (approximately 90%) and [[17-Hydroxyprogesterone|17-hydroxyprogesterone]]  values of less than 7 nmol/L exclude the diagnosis, and values of greater than 45 nmol/L (in women who are nongestational) confirm [[21-hydroxylase deficiency]]. When basal values of [[17-Hydroxyprogesterone|17-hydroxyprogesterone]] are between 7 and 45 nmol/L, an [[ACTH]]-stimulated concentration of greater than 45 nmol/L is also diagnostic.
* Serum [[TSH]] and [[Prolactin]]: [[Hypothyroidism]] and [[hyperprolactinemia]] can lead to hirsutism.<ref name="pmid1905280">{{cite journal |vauthors=Schmidt JB, Lindmaier A, Spona J |title=[Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women] |language=German |journal=Hautarzt |volume=42 |issue=3 |pages=168–72 |year=1991 |pmid=1905280 |doi= |url=}}</ref>
* [[Cortisol]] suppression:
** PCOS and adrenal and ovarian tumors are associated with normal suppression of cortisol by [[dexamethasone]], whereas cortisol levels in patients with [[Cushing's syndrome|Cushing syndrome]] are not suppressed.
 
* Serum [[prolactin]] or [[FSH]]:
** Women with hirsutism and [[amenorrhea]] of unknown cause should have a serum [[prolactin]] or [[FSH]] test to evaluate for either a [[prolactinoma]] or [[ovarian failure]].
* [[Diabetes]] screening:
** Women with hirsutism, [[PCOS]], [[obesity]], or [[acanthosis nigricans]] may have [[insulin resistance]], and screening for diabetes and [[hyperlipidemia]] is recommended.
* [[Prostate specific antigen|Prostate-specific antigen]] ([[Prostate specific antigen|PSA]]):
** Ultrasensitive assays can detect PSA in women and is a potential marker for androgen excess. Studies thus far, however, have not shown a good correlation with the change in androgen levels after treatment. <sup>[[null 11]]</sup><ref name="urlHirsutism Workup: Laboratory Studies, Imaging Studies">{{cite web |url=http://emedicine.medscape.com/article/121038-workup |title=Hirsutism Workup: Laboratory Studies, Imaging Studies |format= |work= |accessdate=}}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[Category:Endocrinology]]
[[Category:Integumentary system]]
[[Category:Gynecology]]
[[Category:Dermatology]]
[[Category:Hair-related diseases]]
{{WH}}
{{WS}}

Latest revision as of 13:43, 10 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Rasam Hajiannasab M.D.[2], Ahmed Younes M.B.B.CH [3]

Overview

Laboratory tests that should be done in hirsutism include testosterone level, DHEAS, and 24-hour cortisol level.

Laboratory Finding

Testosterone

  • Serum testosterone may be normal to increased in case of PCOS and CAH but would be definitely raised (>200 ng/ml) in case of malignant tumor of the adrenal or ovary.[1]

DHEAS

17-Hydroxyprogesterone

  • 17 Hydroxy progesterone: Levels less than 200 ng/dl excludes CAH. Mildly increased levels between 300 and 1,000 ng/dl require an ACTH stimulation test. Cosyntropin (synthetic ACTH), 250 μg, is administered intravenously, and levels of 17-hydroxyprogesterone are measured before and one hour after the injection. Post-stimulation values (>1,000 ng/dl) constitute a positive test.[1]

24-hour urinary cortisol

LH/FSH ratio

Serum TSH

References

  1. ↑ 1.0 1.1 Lin-Su K, Nimkarn S, New MI (2008). "Congenital adrenal hyperplasia in adolescents: diagnosis and management". Ann. N. Y. Acad. Sci. 1135: 95–8. doi:10.1196/annals.1429.021. PMID 18574213.
  2. ↑ Chang RJ, Katz SE (1999). "Diagnosis of polycystic ovary syndrome". Endocrinol. Metab. Clin. North Am. 28 (2): 397–408, vii. PMID 10352925.
  3. ↑ Schmidt JB, Lindmaier A, Spona J (1991). "[Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women]". Hautarzt (in German). 42 (3): 168–72. PMID 1905280.
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