Salivary testosterone measurement in women with and without polycystic ovary syndrome

Thozhukat Sathyapalan,Soha R Dargham,Eric S Kilpatrick,Ahmed Al-Qaissi,Joanne Adaway,Brian Keevil,Stephen L Atkin

doi:10.1038/s41598-017-03945-w

Abstract

Clinical and/or biochemical hyperandrogenism is one of the diagnostic criteria for PCOS. An evaluation of the role of salivary testosterone (salT) and androstenedione (salA) for the diagnosis of PCOS was undertaken in a cross sectional study involving 65 women without PCOS and 110 women with PCOS fulfilling all 3 diagnostic Rotterdam criteria. Serum and salivary androgen measurements were determined by LC-MS/MS. salT and salA were significantly elevated in PCOS compared to controls (P < 001). No androgen marker was more predictive than another using ROC curves, but multiple logistic regression suggested salT was more predictive than free androgen index (FAI) (p < 0.01). The combination of salT or FAI identified 100% of PCOS women. PCOS women with both biochemical and clinical hyperandrogenism as opposed to clinical hyperandrogenism alone showed a metabolic phenotype (p < 0.05) and insulin resistance (p < 0.001). PCOS patients with an isolated elevated FAI showed increased insulin resistance compared to those with an isolated salT (P < 0.05). salT appeared to be at least as predictive as FAI for the diagnosis of the classical PCOS phenotype, and the combination of salT or FAI identified 100% of PCOS patients. This suggests that salT measurement by LC-MS/MS holds the promise of complementing existing laboratory tests as a means of assessing hyperandrogenemia.

Highlights

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders and affects 6–20% of reproductive-aged women[1,2,3]
The areas under the receiver operator curves (ROC) curves showed no significant differences between androgen markers in predicting PCOS, the trend was for free androgen index (FAI) (0.79) and salivary testosterone (salT) (0.76) to be better than serum T, salivary androstenedione (salA), serum A and the salT:salA ratio (0.68, 0.65, 0.66, and 0.65 respectively)
In this study salT appeared to be at least as good as the FAI in identifying patients with PCOS, and both were better than total serum T alone

Summary

Introduction

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders and affects 6–20% of reproductive-aged women[1,2,3]. Saliva is potentially a sample type that will more directly assess a patient’s bioavailable testosterone which, combined with measurement by LC-MS/MS, would be especially applicable to PCOS patients, with possible utility in diagnosis, population research, population screening and treatment monitoring. Such a test sample may prove to be at least www.nature.com/scientificreports/. As acceptable to patients as a venepuncture and could avoid a clinic attendance, especially if collection of multiple samples is required either as part of a clinical investigation or for research

Methods

Results

Conclusion