levels or a free androgen index. An elevated free testosterone level is a
sensitive indicator of androgen excess. Other androgens, such as
dehydroepiandrosterone sulfate (DHEA-S), may be normal or slightly above
the normal range in patients with polycystic ovarian syndrome (PCOS).
levels of sex hormone–binding globulin (SHBG) are usually low in patients
androgen-secreting ovarian or adrenal tumors can present
with hirsutism, amenorrhea, and signs of virilization. Although the clinical
picture of symptom onset and progression is more predictive than androgen
testosterone level may be greater than 150 ng/dL and their
DHEA-S level may be above 800 mcg/dL. DHEA-S is derived from the
adrenal gland, and therefore, elevation of DHEA-S would be suggestive of
an adrenal origin.
The follicle-stimulating hormone (FSH) level should be checked to rule
out primary ovarian failure. In patients with PCOS,
FSH levels are within
the reference range or low.
Luteinizing hormone (LH) levels are elevated for
Tanner stage, sex, and age. The LH-to-FSH ratio is usually greater than 3.
Thyroid dysfunction, rather than PCOS, may be the source of amenorrhea
and hirsutism. (In patients with PCOS, thyroid function tests are within the
Glucose, Insulin, and Lipids will typically be elevated
7. Mammogram and self breast exam recommendations