Page 65 - PCC07

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Recommendations ‐ Hyperandrogenism
EBR
Calculated bioavailable testosterone, calculated free testosterone or free androgen index should be used to assess biochemical hyperandrogenism in the diagnosis of PCOS
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EBR
High quality assays such as liquid chromatography–mass spectrometry (LCMS)/ mass spectrometry and extraction/chromatography immunoassays, should be used for the most accurate assessment of total or free testosterone in PCOS
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EBR
Androstenedione and dehydroepiandrosterone sulfate (DHEAS) could be considered if total or free testosterone are not elevated; however these provide limited additional information in the diagnosis of PCOS
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CR
Direct free testosterone assays, such as radiometric or enzyme‐ linked assays, preferably should not be used in assessment of biochemical hyper‐androgenism in PCOS, as they demonstrate poor sensitivity, accuracy and precision
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Recommendations ‐ Hyperandrogenism
CPP
Reliable assessment of biochemical hyperandrogenism is not possible in women on hormonal contraception, due to effects on sex hormone‐binding globulin and altered gonadotrophin‐ dependent androgen production
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CPP
Where assessment of biochemical hyperandrogenism is important in women on hormonal contraception, drug withdrawal should occur for three months or longer before measurement, and contraception should be managed alternatively during this time
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CPP
Assessment of biochemical hyperandrogenism is most useful in establishing the diagnosis of PCOS, and the phenotype where clinical signs of hyperandrogenism are unclear or absent, in particular hirsutism
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CPP
Interpretation of androgen levels should be guided by the reference ranges of the laboratory used, acknowledging that ranges for different methods and laboratories vary widely. Normal values should ideally be determined by the range of values in a well phenotyped healthy control population or by cluster analysis of a large general population
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CPP
Where androgen levels are markedly above laboratory reference ranges, other causes of biochemical hyperandrogenism, including neoplasia, and rare syndromes of severe insulin resistance, should be considered. History of symptom onset and progression is critical in assessing for neoplasia, however, some androgen‐secreting neoplasms may only induce mild to moderate increases in biochemical hyperandrogenism.
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Page 58 of 196
PRECONGRESS COURSE 07 I BARCELONA, SPAIN – 1 JULY 2018 65