Adrenal PCOS proper testing

[tanyaedwards1969]

Hi Lara,

I have a secondary infertility case of a 33 year old. Tests via her GP look good. Her cycle is 28 days so day 21 progesterone on several occasions has been 55 plus nmol/L. AMH is 26.6 pmol/l, thyroid, Total testosterone, SHBG, LH, FSH, Estradiol, prolactin all look normal. Has been attenpting to fall pregnant for 18 months now and has a 5 year old son from prior successful pregnancy.

She has polcystic ovaries on ultrasound. GP put her on metformin and Letrozole. She has a history of anxiety and panic attacks and has been on SSRI Zoloft for a number of years.

She also has a facial inflammatory condition that is being diagnosed currently. Either rosacea, eczema etc.

I am keen to exclude inflammtory and adrenal PCOS as she also has been losing hair from her head over last couple of years meaning excess androgens from somewhere or androgen sensitivity via inflammation. Her diet is terrible so we are putting in place an anti-inflammatory diet.

Further testing for the adrenal PCOS subtype is where I was hoping to get help.

I am doing an OGGT with Laverty as metformin has made her feel so much better re anxiety , sleep etc and her grandmother was a diabetic.

Testing for other androgens ie. androstenedione and DHEA is where I am a little stuck. I spoke to nutripath who recommended the female hormone test 1004 Plus the 1001 test for DHEA/Cortisol.

I was hoping for some help here....do you have recommnendations for looking at ovarian androstenedione and adrenal plus adrenal DHEA and should I be looking at levels at certain times of the day from your experience????

[Lara]

I usually test for serum DHEA-S, keeping in mind that the reference ranges are age specific.

And just more generally for this patient: Does she have androgen symptoms, ie hirsutism? Because if not, then there's not really any reason to think it's PCOS. The polycystic ovary finding means nothing. I'm just about to release a podcast about that which I'll link to.

[tanyaedwards1969]

Hi Lara,

She has has significant hair loss on her head and it may be a form of acne on her face? No other obvious hair growth...

[Lara]

Do you happen to have a day 2 LH and FSH readings? because that's another helpful consideration when deciding if PCOS or not.

The part thinning androgenic type of hair loss can be an androgen sign, but of course, hair loss can also be from thyroid, iron deficiency, etc.

[Lara]

See my podcast PCOS cannot be diagnosed by ultrasound.