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Horm Metab Res 2008; 40(11): 813-818
DOI: 10.1055/s-0028-1087186
Humans, Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Testosterone and Bioavailable Testosterone Help to Distinguish between Mild Cushing's Syndrome and Polycystic Ovarian Syndrome[*]

M. E. Pall 2 , M. C. Lao 2 , S. S. Patel 2 , M. L. Lee 1 , D. E. Ghods 1 , D. W. Chandler 3 , T. C. Friedman 1
  • 1Division of Endocrinology, Metabolism, and Molecular Medicine, The Charles Drew University of Medicine and Science, Los Angeles, CA, USA
  • 2Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
  • 3Esoterix Laboratories, Calabasas Hills, CA, USA
Further Information

Publication History

received 10.03.2008

accepted 26.06.2008

Publication Date:
25 September 2008 (online)

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Abstract

Women with Cushing's syndrome (CS) and polycystic ovarian syndrome (PCOS) may present with similar symptoms. Subjects with mild CS lack clinical stigmata of classical CS and often have normal laboratory tests measuring hypercortisolism. Thus, distinguishing mild CS from PCOS may be difficult. We hypothesized that either total testosterone (TT) or bioavailable testosterone (BT) levels or the calculation of the free androgen index (FAI) would be low in patients with mild CS and elevated in patients with PCOS, and could help differentiate the two conditions. TT, BT, and FAI were measured in a group of 20 patients of reproductive age with mild CS and 20 PCOS patients matched for age and BMI. We used receiver operator characteristic (ROC) curves to assess the sensitivity and specificity of these measurements for the diagnosis of CS. TT (p<0.0001), BT (p=0.02), and FAI (p=0.003) were significantly elevated in PCOS patients compared to mild CS patients. Sex hormone-binding globulin was similar in both groups. The optimal cut-point for TT was 1.39 nmol/L, yielding a sensitivity of 95% and a specificity of 70%. The cut-point for BT was 0.24 nmol/L, resulting in a sensitivity of 75% and a specificity of 80%. The cut-point for FAI was 5.7, with a sensitivity of 88% and a specificity of 60%. We conclude that TT levels may be useful to discriminate between mild CS and PCOS. In patients with signs and symptoms consistent with CS and PCOS, a TT level of <1.39 nmol/L warrants a workup for CS.

Key words

Cushing's syndrome - PCOS - episodic - periodic - androgens - testosterone - ROC

1 Some of this work was presented in abstract form at the 88th Endocrine Society meeting in 2005.

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1 Some of this work was presented in abstract form at the 88th Endocrine Society meeting in 2005.

Correspondence

T. C. FriedmanMD, PhD 

The Charles R. Drew University of Medicine & Sciences

Division of Endocrinology

1731 E. 120th St.

Los Angeles

90059 CA

USA

Phone: +1/310/668 51 97

Fax: +1/323/563 93 24

Email: tefriedm@cdrewu.edu