Endocrine Abstracts

Introduction: Hyperandrogenism is a diagnostic feature for polycystic ovarian syndrome (PCOS). Androstenedione is a testosterone precursor that has been shown to be useful in diagnosis of PCOS especially in the setting of normal testosterone. During 2022, our laboratory in St Vincent’s University Hospital in Dublin, Ireland, changed from using a radioimmunoassay to an electrochemiluminescence immunoassay, which requires a non-gel tube in line with manufacturers requirements. In the endocrinology department we noticed that many samples were not being processed in the lab due to incorrect tube use. We audited the androstenedione levels processed in St. Vincent’s University Hospital over a four-month period at the start of 2023 and analysed results in conjunction with the other serum androgens, testosterone and dehydroepiandrosterone sulfate (DHEAS).

Results: 145/319 androstenedione samples were analysed. 41/145 samples were above the upper limit of normal (>4.6 nmol/l), all in female patients. 17/41 had normal testosterone levels (0.4-1.7 nmol/l). This is significant as elevated androstenedione confirmed biochemical hyperandrogenism and a diagnosis of PCOS in 8/17 despite normal testosterone.

Conclusion: The findings support the 2023 International Evidence based guideline for PCOS, which recommend doing androstenedione and DHEAS in patients with normal testosterone.

Recommendations: This audit identifies a need to educate users of sample tube requirements and encourages communication with clinical biochemistry; androstenedione remains part of the biochemical workup of PCOS, as it can identify more subtle hyperandrogenism; reflective or reflex laboratory testing could be an option for adding androstenedione levels, in cases with normal testosterone.

Reference: 1. Teede HJ, Tay CT, et al. (2023) Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. doi:10.1210/clinem/dgad463