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Markers of hyperandrogenism in South Asians with polycystic ovary syndrome

Authors:

WMM Boteju ,

University of Colombo, LK
About WMM
Department of Obstetrics and Gynaecology, Faculty of Medicine
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GDKN Karunarathna,

University of Colombo, LK
About GDKN
Department of Obstetrics and Gynaecology, Faculty of Medicine
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SAD Udayangani,

University of Colombo, LK
About SAD
Department of Obstetrics and Gynaecology, Faculty of Medicine
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KGH Silva,

University of Colombo, LK
About KGH
Department of Obstetrics and Gynaecology, Faculty of Medicine
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CN Wijeyaratne

De Soysa Hospital for Women, LK
About CN
Professorial Unit
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Abstract

Background: Many clinical and biochemical criteria are used to assess hyperandrogenism in subjects with polycystic ovary syndrome (PCOS). Standard indicators used to confirm hyperandrogenism are based predominantly on western data. Whilst the phenotype of PCOS has ethnic specific variation, specific cutoffs for hyperandrogenism in South Asians have not been defined.

Objectives: To evaluate the effectiveness of modified Ferriman-Gallwey score (FG Score), serum total testosterone and free androgen index (FAI) in the assessment of hyperandrogenism in PCOS.

Materials and methods: A case control study was conducted on 100 women aged 20-45 years (mean age=30) attending a specialized endocrine clinic in Colombo, Sri Lanka from 1st January 2010 to 1st June 2013. Confirmed cases with PCOS (Rotterdam criteria 2003) were age matched for controls from healthy volunteers. Recommended cut-offs for hyperandrogenism: FG score ≥8, testosterone (T) >3.5 nmol/L and FAI >5 were applied and receiver operating characteristics (ROC) curves were drawn to compare the diagnostic power of each parameter.

Results: 50 cases with PCOS and 50 controls were studied. Cases versus controls had significantly greater FG score, testosterone and FAI:median FG=10 vs 3, mean testosterone 2.762±1.78 vs 1.045± 0.40 (p=0.0001), mean FAI 7.31±7.55 vs 3.64±4.87 (p= 0.01);76% cases and 4% controls had FG score ≥8 (p=0.0001), 30% cases had elevated (T) with none among controls (p=0.00001), 43.3% cases and 14.7% controls had FAI ≥5 (p=0.002). The diagnostic power of serum testosterone was greater than that of FAI in subjects with FG score ≥8. Area under the curve (AUC) for T and FAI were 0.832 and 0.766 respectively.

Conclusion: Clinical assessment by FG score detects hyperandrogenism in PCOS patients more frequently compared to serum testosterone and free androgen index. A higher detection rate was observed in controls when FAI was used as the indicator, suggesting a possible influence from changes in SHBG concentration. Hence, total testosterone having greater diagnostic power than FAI in confirming hyperandrogenism, is the recommended biochemical test in the diagnostic work up of PCOS.

DOI: http://dx.doi.org/10.4038/sjdem.v4i1.7240

Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2014; 4: 3-8

DOI: http://doi.org/10.4038/sjdem.v4i1.7240
How to Cite: Boteju, W. et al., (2014). Markers of hyperandrogenism in South Asians with polycystic ovary syndrome. Sri Lanka Journal of Diabetes Endocrinology and Metabolism. 4(1), pp.3–8. DOI: http://doi.org/10.4038/sjdem.v4i1.7240
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Published on 01 Aug 2014.
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