Receiver operating characteristic analysis of the performance of basal serum hormone profiles for the diagnosis of polycystic ovary syndrome in epidemiological studies

• Published in: European journal of endocrinology Vol. 145; no. 5; pp. 619 - 624
• Main Authors: ESCOBAR-MORREALE, Héctor F, ASUNCION, Miryam, CALVO, Rosa M, SANCHO, José, SAN MILLAN, José L
• Format: Journal Article
• Language: English
• Published: Colchester Portland Press 01-11-2001
• Subjects: Adult; Biological and medical sciences; Dehydroepiandrosterone Sulfate - blood; Estradiol - blood; Female; Female genital diseases; Follicle Stimulating Hormone - blood; Genital system. Mammary gland; Gonadal Steroid Hormones - blood; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Luteinizing Hormone - blood; Medical sciences; Menstruation - physiology; Ovulation - physiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Polycystic Ovary Syndrome - diagnosis; Polycystic Ovary Syndrome - epidemiology; Prospective Studies; Reference Standards; ROC Curve; Sex Hormone-Binding Globulin - metabolism; Testosterone - blood; Tumors; Performance evaluation; Sex hormone binding protein; Polycystic ovary; Glycoprotein hormone; Epidemiology; Estradiol; Cyst; Female; Serum; Benign neoplasm; Diagnosis; Hormonal investigation; Quantitative analysis; Follicle stimulating hormone; Human; Biochemical analysis; Androgen; Female sterility; Gonadotropin; Ovarian hormone; Female genital diseases; Ovarian diseases; Adenohypophyseal hormone; Receiver operating characteristic curves; Technique; Sex steroid hormone
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/eje.0.1450619

We have used receiver operating characteristic (ROC) analysis to determine the diagnostic performance of several serum parameters, in order to evaluate their potential usefulness in establishing the diagnosis of polycystic ovary syndrome (PCOS) in epidemiological studies.
Prospective study.
One hundred and fourteen women reporting spontaneously for blood donation were included in the study. Menopausal and oral contraceptive-treated women were excluded. Serum samples were obtained at the moment of donation, independently of fasting, time of day or day of menstrual cycle. Measurements included total testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), LH, FSH and estradiol. The free testosterone (FT) concentration and the free androgen index (FAI) were calculated from testosterone and SHBG levels. ROC curves were calculated for all these serum determinations.
Eight patients were diagnosed with PCOS, according to the presence of oligomenorrhea, hirsutism, acne and/or hyperandrogenemia, and exclusion of non-classic congenital adrenal hyperplasia, hypothyroidism and hyperprolactinemia. Of the parameters studied SHBG, FAI, FT and DHEAS were considered adequate measures for the diagnosis of PCOS. For example, serum SHBG levels showed an area under the ROC curve of 0.875+/-(S.E.(w))0.045 (95% confidence interval 0.800-0.929). A SHBG decision threshold <37 nmol/l had a sensitivity of 87.5%, a specificity of 86.8%, a positive likelihood ratio of 6.63, and a negative likelihood ratio of 0.14, for the diagnosis of PCOS.
Our present results strongly suggest that decreased SHBG levels, and increased FAI, free testosterone concentration and DHEAS concentrations, are highly effective as single analytical procedures in epidemiological studies for the detection of PCOS in women of reproductive age.