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- Title
Performance of mass spectrometry steroid profiling for diagnosis of polycystic ovary syndrome.
- Authors
Handelsman, D. J.; Teede, H. J.; Desai, R.; Norman, R. J.; Moran, L. J.
- Abstract
<bold>Study Question: </bold>How well does multi-analyte steroid mass spectrometry (MS) profiling classify women with and without polycystic ovary syndrome (PCOS)?<bold>Summary Answer: </bold>Our liquid chromatography MS (LC-MS) steroid profiling only minimally improves discrimination of women with and without PCOS compared with a direct testosterone immunoassay (T_IA) and the free androgen index (FAI).<bold>What Is Known Already: </bold>Blood testosterone measured by direct (non-extraction) immunoassay overlaps between women with and without PCOS. Multi-analyte MS provides greater specificity and accuracy for steroid measurement so might improve the classification.<bold>Study Design, Size, Duration: </bold>An observational, cross-sectional study of women with PCOS (n = 152) defined by Rotterdam criteria and matched non-PCOS (n = 45) control women was conducted.<bold>Participants/materials, Setting, Methods: </bold>Serum steroid profiles of testosterone (T), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), androstenedione (A4), estradiol (E2), estrone (E1), 17 hydroxy progesterone (17OHP4), progesterone (P4) and cortisol were measured by LC-MS; T_IA and sex hormone binding globulin were measured by immunoassay; and FAI, calculated free testosterone (cFT) and total androgen index (TAI) were calculated. Classification was based on logistic regression with corresponding univariate and multivariate C-statistics.<bold>Main Results and the Role Of Chance: </bold>Serum testosterone by immunoassay demonstrated levels more than 100% higher than that measured by LC-MS. Compared with the controls, women with PCOS had higher serum T, DHEA, A4, TAI, T_IA, cFT, FAI and E2 but not serum DHT, E1, P4, 17OHP4 or cortisol. Univariate C-statistics were highest for FAI (0.89) and T_IA (0.82) compared with other androgens (T [0.72], DHT [0.40]), pro-androgens (A4 [0.74], DHEA[0.71]) or derivatives (cFT [0.75], TAI [0.60]). For all multivariate models, the overall correct predictions (81-86%) featured high sensitivity (92-96%) but low specificity (28-43%). and substituting LC-MS steroid measurements for T_IA and FAI produced only minimal improvements in classification.<bold>Limitations Reasons For Caution: </bold>The study cohort is limited in size and only unconjugated steroids were measured.<bold>Wider Implications Of the Findings: </bold>Multi-analyte steroid profiling of unconjugated circulating steroids provides only limited improvement on direct T_IA in classifying women with and without PCOS.<bold>Study Funding/competing Interests: </bold>None.<bold>Trial Registration Number: </bold>N/A.
- Subjects
POLYCYSTIC ovary syndrome; MASS spectrometry; STEROID hormones; TESTOSTERONE; IMMUNOASSAY; LIQUID chromatography; DIAGNOSIS; ANDROGENS; ESTROGEN; HYDROCORTISONE; PROGESTATIONAL hormones; CROSS-sectional method
- Publication
Human Reproduction, 2017, Vol 32, Issue 2, p418
- ISSN
0268-1161
- Publication type
journal article
- DOI
10.1093/humrep/dew328