Polycystic ovary syndrome laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Measurement of the plasma levels of several hormones is helpful in supporting the diagnosis of PCOS and especially in excluding other disorders. Determining the LH/FSH ratio of 3:1 is virtually diagnostic of PCOS. However, a normal ratio does not exclude the diagnosis, as LH levels fluctuate widely throughout the course of a day. Other androgens are measured to screen for other virilizing adrenal tumors. Fasting blood glucose is measured to look for diabetes, screening for lipid abnormalities is also employed. Testosterone is measured to exclude a virilizing tumor. Prolactin is measured to exclude a prolactinoma. Thyroid-stimulating hormone (TSH) is measured to rule out hypothyroidism.

Laboratory Findings

Measurement of the plasma levels of several hormones is helpful in supporting the diagnosis of PCOS and especially in excluding other disorders. Determining the LH/FSH ratio of 3:1 is virtually diagnostic of PCOS. However, a normal ratio does not exclude the diagnosis, as LH levels fluctuate widely throughout the course of a day. Other androgens are measured to screen for other virilizing adrenal tumors. Fasting blood glucose is measured to look for diabetes, screening for lipid abnormalities is also employed. Testosterone is measured to exclude a virilizing tumor. Prolactin is measured to exclude a prolactinoma. Thyroid-stimulating hormone (TSH) is measured to rule out hypothyroidism.

Harmone		Normal value	PCOS Laboratory Findings
LH/FSH ratio		<3;1	A ratio >3:1 is indicative of PCOS
Testosterone		Free: 100 to 200 pg/dL Total: 20 to 80 ng/dL	An elevated free testosterone level (200-400 pg/dL) is suggestive of PCOS,
Prolactin		3.8 to 23.2 μg/L	A level >300 μg/L is virtually diagnostic of prolactinoma.
TSH		0.4 to 4.2 mIU/L	Levels are normal in patients with PCOS
Androgens	Sex hormone–binding globulin	1.5 to 2.0 μg/mL	Decreased
	Androstenedione	75 to 205 ng/dL	Increased
	Estrone	1.5 to 25.0 pg/mL	Increased
	Dehydroepiandrosterone sulfate	50 to 450 μg/dL	Increased but are <800 μg/dL
	17-Hydroxyprogesterone	15 to 70 ng/dL	Normal
Fasting blood glucose		<110 mg/dL	>126mg/dL Indicates DM

Approach to hyperandrogenism

Signs of hyperandrogenism hirsutism, alopecia, masculine appearance, acne

History of Drug use

Presence of oligomenorrhea

Stop using the drug PCOS ruled out

Perform an ultrsound of pelvis

Normal morphology of ovaries

Cystic morphology of ovaries

PCOS is ruled out Look for adrenal tumors, ovarian tumors

Measure testosterone levels

*17-hydroxyprogesterone/DHEAs elevated = CAH,adrenal tumors *Cortisol elevated = Cushings syndrome, cortisol resistance Prolactin,TSH,IGF1 abnormal = hyperprolactinoma, thyroid dysfunction acromegaly

Normal

Elevated

Risk factors of Hirsutism present?

PCOS

No

Yes

PCOS ruled out

Hirsutism present?

Mild hirsutism

Severe Hirutism

PCOS

Trial of OCP

Positive response

Negative worsening of symptoms

Idiopathic hirsutism

PCOS