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1: Simultaneous Measurement of Testosterone and Androstenedione in Women with Suspected Androgen Excess Katherine Duxbury

3: Androgens C19 steroid hormones that contribute to the development of secondary sexual characteristics

4: Androgens in Disease Clinical features of hyperandrogenism: Hirsutism Acne Virilisation

5: PCOS Heterogenous syndrome of ovarian dysfunction Consensus of diagnostic criteria (2 out of 3) (i) Oligo- or anovulation (ii) Clinical and/or biochemical signs of hyperandrogenism (iii) Polycystic ovaries on USS And exclusion of other aetiologies (CAH, androgen secreting tumours, Cushing’s syndrome)

6: Previous Practice Assessment of androgen status;

7: LC-MS/MS Simultaneous Method

8: Reference Ranges Testosterone 0.27-1.6 nmol/L

9: This Project Aim Assess the impact of simultaneous measurement Method Data collected on 310 female samples June to October 2005 Testosterone and androstenedione simultaneous measurement SHBG for FAI calculation

10: Overall Findings

11: Advantages of Simultaneous Measurement Faster service More evidence for the clinician to more confidently confirm or refute biochemical hyperandrogenism More information at no extra expense

13: Androstenedione Concentrations

14: Further Investigation

15: Results of Further Investigations

16: Menstrual Cycle Variation

17: Circadian Variation Endocrine Regulations 1998 32 169-176

19: Conclusions The simultaneous measurement of androstenedione and testosterone may offer advantages: (i) 32% of patients received a faster service (ii) more evidence at no extra cost A consequence of simultaneous measurement is the identification of a group of patients with an isolated raised androstenedione. Obtaining more clinical data about these patients has not yet concluded whether such a result is consistent with PCOS.

20: Further Work Continue requesting extra clinical details for patients with isolated raised androstenedione levels as they are encountered Investigate the effects of the menstrual cycle on androstenedione levels Presenting the data to the endocrinology staff and feeding back to the GPs

21: Acknowledgements GPs Louise Gallagher Anne Marie Kelly Brian Keevil

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