Polycystic ovary syndrome and the differential diagnosis of hyperandrogenism

Authors

  • Claire L Meek MB ChB BSc(Med Sci) MSc MRCP,

    Specialist Registrar, Corresponding author
    • Chemical Pathology & Metabolic Medicine, Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
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  • Vassiliki Bravis MA (Hons) MBBS MRCP MRes,

    Academic Clinical Fellow in Endocrinology and Diabetes
    1. Department of Endocrinology, Lister Hospital, Corey's Mill Lane, Stevenage SG1 4AB and Department of Investigative Sciences, Imperial College, London, UK
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  • Abigail Don BMBCh and BA (Hons),

    FY2 Doctor in Endocrinology & Diabetes
    1. Department of Endocrinology, Lister Hospital, Corey's Mill Lane, Stevenage SG1 4AB, UK
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  • Felicity Kaplan MBChB, FCP(SA), FRCP

    Consultant in Endocrinology & Diabetes
    1. Department of Endocrinology, Lister Hospital, Corey's Mill Lane, Stevenage SG1 4AB, UK
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Correspondence: Claire Meek. Email: claire.meek@nhs.net

Abstract

Key content

  • The presence of clinical or biochemical evidence of hyperandrogenism is a defining feature of polycystic ovary syndrome (PCOS).
  • As the criteria for diagnosing PCOS becomes more inclusive, there is an increased risk of misdiagnosing women with other causes of hyperandrogenism.
  • Biochemical testing for serum testosterone concentrations in women has important limitations.
  • Patients with concerning features should be investigated for other causes of hyperandrogenism.

Learning objectives

  • To review the different criteria for diagnosing PCOS and the repercussions for disease prevalence.
  • To learn about the differential diagnosis of hyperandrogenism.
  • To learn about the limitations of biochemical testing for testosterone in women.

Ethical issues

  • Hyperandrogenism causing hirsutism and virilisation can have significant effects on physical and psychological wellbeing.
  • Misdiagnosis can delay appropriate treatment and may affect future fertility.

Ancillary