Diagnosis of hyperandrogenism: biochemical criteria.
Biochemical derangements in ovarian, adrenal, and peripheral androgen production and metabolism play an important role in underlying causes of hyperandrogenism. Specific diagnostic serum markers such as testosterone (total) and dehydroepiandrosterone sulfate (DHEAS), respectively, may be helpful in the diagnosis of ovarian and adrenal hyperandrogenism, respectively. Validated immunoassays or mass spectrometry assays should be used to quantify testosterone, DHEAS and other principal androgens. Free testosterone measurements, determined by equilibrium dialysis or the calculated method, are advocated for routine evaluation of more subtle forms of hyperandrogenism. The skin, with its pilosebaceous units (PSUs), is an important site of active androgen production. A key regulator in PSUs is 5alpha-reductase, which transforms testosterone or androstenedione to dihydrotestosterone (DHT). DHT in blood is not effective in indicating the presence of hyperandrogenism. However, distal metabolites of DHT have been shown to be good markers of clinical manifestations of hirsutism, acne and alopecia. Assays for these peripheral markers need improvement for routine clinical testing.
Stanczyk
Frank Z
FZ
Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Women's and Children's Hospital, Room 1M2, 1240 North Mission Road, Los Angeles, CA 90033, USA. fstanczyk@socal.rr.com
D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase / Q000032:analysis; D000152:Acne Vulgaris / Q000378:metabolism; D000505:Alopecia / Q000378:metabolism; D000645:Ammonium Sulfate; D000728:Androgens / Q000378:metabolism* / Q000502:physiology; D000735:Androstenedione / Q000097:blood; D011232:Chemical Precipitation; D003687:Dehydroepiandrosterone / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D003956:Dialysis; D013196:Dihydrotestosterone / Q000097:blood; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D018859:Hair Follicle / Q000187:drug effects; D006628:Hirsutism / Q000378:metabolism; D006801:Humans; D017588:Hyperandrogenism / Q000175:diagnosis* / Q000378:metabolism; D011863:Radioimmunoassay; D012016:Reference Values; D013739:Testosterone / Q000097:blood
D000728:Androgens; D013196:Dihydrotestosterone; D013739:Testosterone; D000735:Androstenedione; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D013741:3-Oxo-5-alpha-Steroid 4-Dehydrogenase; D000645:Ammonium Sulfate