MANAGEMENT OF ENDOCRINE DISEASE Hyperandrogenic states in women: pitfalls in laboratory diagnosis.
Level 5 - mechanism / opinion, no new human data
Narrative review and expert guidance without original empirical data or systematic review methodology
PubMed 29453202 · doi:10.1530/EJE-17-0776
What was done
This narrative clinical review examines laboratory diagnostic methods and analytical pitfalls in evaluating female hyperandrogenic states. Based on the abstract, it outlines the limitations and requirements of total testosterone measurement, comparing direct immunoassays (with monoclonal antibodies, ideally post-extraction) to liquid chromatography-tandem mass spectrometry (LC-MS/MS), and discusses the impact of sex-hormone-binding globulin (SHBG) variations and adrenal androgen testing.
What was found
The abstract reports no empirical numbers or quantitative assay comparisons. It notes that low circulating testosterone levels and structural similarities among circulating androgens create measurement pitfalls requiring high-specificity, high-sensitivity techniques with external quality control and standardization. In overweight hyperandrogenic patients, low SHBG levels frequently lower circulating total testosterone into the normal range, masking androgen excess; measuring SHBG and calculating free testosterone is identified as a key method to avoid this diagnostic error.
Why it matters
Routine total testosterone immunoassays can miss hyperandrogenism in women, especially when low SHBG masks elevated androgen activity. Recognizing assay limitations and calculating free testosterone improves diagnostic accuracy in suspected androgen excess disorders.
Limits
The abstract describes a narrative review without original data, systematic review methodology, or meta-analytic pooling. No quantitative accuracy metrics (e.g., sensitivity, specificity, limit of detection values) or sample sizes are reported.
Cited by
- supports Standard clinical hormone assays used historically have lacked the sensitivity to accurately detect normal low circulating testosterone levels in women.