Hirsutism laboratory findings: Difference between revisions

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The laboratory findings
The laboratory findings
* [[Testosterone]], total and free:  
* [[Testosterone]], total and free:  
** 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.
** 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. A total serum testosterone level > 200ng/mL suggest an androgen producing tumor.
A total serum testosterone level > 200ng/mL suggest an androgen producing tumor.


* [[Dehydroepiandrosterone sulfate]] (DHEAS):  
* [[Dehydroepiandrosterone sulfate]] (DHEAS):  
** 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.
** 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. DHEAS > 700microgram/microliter suggests an androgen producing adrenal tumor.
DHEAS > 700microgram/microliter suggests an androgen producing adrenal tumor.
* [[Dexamethasone suppression test|Dexamethasone suppression]]:
* [[Dexamethasone suppression test|Dexamethasone suppression]]:
** [[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.
** [[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.

Revision as of 16:29, 15 September 2017

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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 Findings

The laboratory findings

  • Testosterone, total and free:
    • 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 or 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. A total serum testosterone level > 200ng/mL suggest an androgen producing tumor.

References

  1. "Hirsutism Workup: Laboratory Studies, Imaging Studies".

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