British Journal of Obstetrics and Gynaecology March 1992, Vol. 99, pp. 232-238
GYNAECOLOGY
Which hormone tests for the diagnosis of polycystic ovary syndrome? S. ROBINSON D. A. RODIN Endocrine Research Group Clinical Research Centre Watford Road Harrow, Middlesex, UK. A. DEACON Department of Clinical Chemistry Northwick Park Hospital Harrow, Middlesex, UK M. J . W H E E L E R Department of Chemical Pathology St Thomas’s Hospital Medical School London, UK R. N . CLAYTON Endocrine Research Group Clinical Research Centre Watford Road Harrow, Middlesex, UK
ABSTRACT Objective To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS). Hormone measurements in 63 unselected women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovulatory controls in the early follicular phase of their cycles. Measurements Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays. Results The mean serum LH and LH/FSH ratio were significantly (P 3 and elevated androgens. We found that women with the clinical features of PCOS did not have a high LH/FSH ratio, especially when the assay for gonadotrophins was changed from radioimmunoassay (RIA) to an immunoradiometric assay (IRMA). Consequently, we decided to assess the frequency with which serum LH, LH/FSH ratio, as measured by two different methods, and serum androgens (total testosterone, derived free testosterone and androstenedione) were elevated in women with PCOS, and thereby their diagnostic utility.
Subjects and methods Data from 63 women with PCOS attending gynaecological and general endocrine clinics were compared with those from 20 women from amongst hospital staff or women from couples whose infertility was due to a clearly defined male factor. All women had regular ovulatory menstrual cycles. We defined PCOS by the observation of polycystic ovaries (PCO) during pelvic ultrasound scanning associated with either oligomenorrhoea (intermenstrual interval >35 days) with or without hirsutism (Ferriman & Gallwey score >7). Polycystic ovaries were defined as ovaries containing 2 10 cysts of 2-10 mm diameter arranged around the periphery or throughout the ovary accompanied by increased stroma (Adams et al. 1986). No individual in the study group had megalocystic ovaries associated with weight loss related or hypothalamic amenorrhoea. Ovarian volume was calculated from the formula for a prolate ellipsoid (Orsini et al. 1985). The mean age (SD) of the PCOS group was 27 (5.0) years compared with 26 (5.0 years) in the control group. The mean body mass index (BMI) in the PCOS group, 25.9 (6.0), was significantly higher (P25, none was underweight (BMIc17); 66.6% in the PCOS group had hirsutism and 67% oligo or amenorrhoea, many exhibiting both features. The mean ovarian volume in the PCOS group was 10.1 ml (SD4.1) compared with 5.0 ml (1.4) in the control group (P25 nmol/l. All blood samples were taken on the day of the ultrasound scan, which was performed within 5 days of menstruation in the control group and, wherever possible, the same time after a spontaneous period in the PCOS group or randomly in women with severe oligomenorrhoea or amenorrhoea. In the latter, recent ovulation was excluded by progesterone measurement (
GYNAECOLOGY
Which hormone tests for the diagnosis of polycystic ovary syndrome? S. ROBINSON D. A. RODIN Endocrine Research Group Clinical Research Centre Watford Road Harrow, Middlesex, UK. A. DEACON Department of Clinical Chemistry Northwick Park Hospital Harrow, Middlesex, UK M. J . W H E E L E R Department of Chemical Pathology St Thomas’s Hospital Medical School London, UK R. N . CLAYTON Endocrine Research Group Clinical Research Centre Watford Road Harrow, Middlesex, UK
ABSTRACT Objective To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS). Hormone measurements in 63 unselected women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovulatory controls in the early follicular phase of their cycles. Measurements Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays. Results The mean serum LH and LH/FSH ratio were significantly (P 3 and elevated androgens. We found that women with the clinical features of PCOS did not have a high LH/FSH ratio, especially when the assay for gonadotrophins was changed from radioimmunoassay (RIA) to an immunoradiometric assay (IRMA). Consequently, we decided to assess the frequency with which serum LH, LH/FSH ratio, as measured by two different methods, and serum androgens (total testosterone, derived free testosterone and androstenedione) were elevated in women with PCOS, and thereby their diagnostic utility.
Subjects and methods Data from 63 women with PCOS attending gynaecological and general endocrine clinics were compared with those from 20 women from amongst hospital staff or women from couples whose infertility was due to a clearly defined male factor. All women had regular ovulatory menstrual cycles. We defined PCOS by the observation of polycystic ovaries (PCO) during pelvic ultrasound scanning associated with either oligomenorrhoea (intermenstrual interval >35 days) with or without hirsutism (Ferriman & Gallwey score >7). Polycystic ovaries were defined as ovaries containing 2 10 cysts of 2-10 mm diameter arranged around the periphery or throughout the ovary accompanied by increased stroma (Adams et al. 1986). No individual in the study group had megalocystic ovaries associated with weight loss related or hypothalamic amenorrhoea. Ovarian volume was calculated from the formula for a prolate ellipsoid (Orsini et al. 1985). The mean age (SD) of the PCOS group was 27 (5.0) years compared with 26 (5.0 years) in the control group. The mean body mass index (BMI) in the PCOS group, 25.9 (6.0), was significantly higher (P25, none was underweight (BMIc17); 66.6% in the PCOS group had hirsutism and 67% oligo or amenorrhoea, many exhibiting both features. The mean ovarian volume in the PCOS group was 10.1 ml (SD4.1) compared with 5.0 ml (1.4) in the control group (P25 nmol/l. All blood samples were taken on the day of the ultrasound scan, which was performed within 5 days of menstruation in the control group and, wherever possible, the same time after a spontaneous period in the PCOS group or randomly in women with severe oligomenorrhoea or amenorrhoea. In the latter, recent ovulation was excluded by progesterone measurement (
