Endocrine Abstracts

We report a 26 year old Asian lady referred to our clinic with secondary infertility and a raised testosterone. She had miscarried at 6 weeks a year earlier. Over the last 6 months her periods had become irregular (every 6–8 weeks) had gained 9 kilograms in weight despite an unchanged diet. Along with this she had noticed an increase in facial and body hair. Testosterone checked by her GP was markedly elevated at 5.2 nmols/L (N<2.8).Prolactin 214 mu/L (0–650), LH 35.8 U/L, FSH 5.3 and oestradiol 444 pmol/L were normal.

On examination she was hirsute (Ferriman-Gallwey score 19), BP 130/100 but the rest of physical examination was non contributory. By the time of her appointment she had managed with the help of diet and exercise to lose the excess weight that she had earlier gained and currently weighed 64 kilograms. BMI had dropped during this time from 30.4 to 26.7 kg/m². Her periods had recommenced 2 weeks earlier. Repeat testosterone was 2.5 nmols/l, SHBG 42 (18–114), DHEA Sulphate 2.0μmol/L (3.3–8.2), androstenedione 4.9μmols/L (1.7–9.3), 17-OHP 2.3 nmol/L. An overnight 1 mg dexamethasone suppression test in view of hypertension was normal (9 am cortisol 25 nmol/L). She has continued to lose weight, her menstrual cycle is now regular (every 28 days) and ovulation confirmed by day 21 progesterone of 44 nmols/L. Hair growth has dramatically improved. Testosterone is now 2.1 nmols/L.

Hyperandrogenism and anovulation are central to the diagnosis of polycystic ovarian syndrome (PCOS). Recovery of normal menstruation and ovulation in response to weight loss is well recognised. It is unusual to have such severe hyperandrogenism as was in this lady with presumed PCOS. Interestingly her symptoms were brought on by recent weight gain and these as well as the biochemical abnormalities corrected themselves with weight loss that should always remain central to the management of this condition.