Dexamethasone suppression test versus selective ovarian and adrenal vein catheterization in identifying virilizing tumors in postmenopausal hyperandrogenism – a systematic review and meta-analysis

Abstract

Objective The diagnostic accuracy of tests in identifying virilizing tumors in postmenopausal hyperandrogenism is limited. This systematic review compares the dexamethasone suppression test against selective ovarian and adrenal vein sampling of androgens in distinguishing neoplastic from non-neoplastic causes of postmenopausal hyperandrogenism. Methods Diagnostic test accuracy studies on these index tests in postmenopausal women were selected based on pre-established criteria. The true positive, false positive, false negative, and true negative values were extracted and meta-analysis was conducted using the hierarchical summary receiver operator characteristics curve method. Results The summary sensitivity of the dexamethasone suppression test is 100% (95% CI 0–100%) and that for selective venous sampling is 100% (95% CI 0–100%). The summary specificity of the dexamethasone suppression test is 89.2% (95% CI 85.3–92.2%) and that for selective venous sampling is 100% (95% CI 0.3–100%). Conclusion There is limited evidence for the use of dexamethasone suppression test or selective venous sampling in identifying virilizing tumors in postmenopausal hyperandrogenism.