PCOS short

• Most society guidelines have accepted that diagnosis of PCOS most meet 2 out of 3 criteria; chronic anovulation, clinical or biological hyperandrogenism, and polycystic ovaries morphology in the absence of any other pathology. This is well known as Rotterdam criteria. The National Institute of Health requires clinical or biochemical hyperandrogenism and oligo or anovulation. American Excess PCOS Society requires hyperandrogenism with 1 of 2 of the remaining criteria.
• Disorders that mimic the clinical features of PCOS should be excluded. These include thyroid disease, hyperprolactinemia, and nonclassic congenital adrenal hyperplasia with 21-hydroxylase deficiency. Diagnosis of this requires measurement of serum 17-hydroxyprogesterone [17-OHP], which may require further testing with adrenocorticotropin stimulation test.
• Free testosterone levels are more sensitive than the measurement of total testosterone for establishing the existence of androgen excess. Methodologic problems in commercial testosterone assays have emerged. Providers should be aware of the method used by the laboratory. Equilibrium dialysis technique such as mass spectrometry coupled with liquid chromography have the highest sensitivity and specificity and give accurate results. Direct analog radioimmunoassay does not give reliable results, though RIA with purification techniques has shown to be more accurate. It is preferable to rely on calculated free testosterone when equilibrium dialysis method is not available.
• The value of measuring levels of androgens other than free testosterone is relatively low. Although dehydroepiandrosterone sulfate (DHEAS) levels are increased in 30% to 35% of patients with PCOS and it has been estimated that 5% of patients have an exclusive increase in DHEAS.