Supervisors info:
Ρίζος Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαστοράκος Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γρηγορίου Οδυσσέας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Μελέτη των επιπέδων των ανδρογόνων (DHEAS, TESTO, D4-Androstendione), του δείκτη ελεύθερων ανδρογόνων (FAI) και της SHBG σε σχέση με την ηλικία της γυναίκας και με άλλες παραμέτρους
Translated title:
Evaluation of relationship between androgen levels (DHEAS, TESTO, D4-Androstendione), free androgen index (FAI), and SHBG according to age and other parameters in women
Summary:
Introduction
Androgens, in order of decreasing serum concentration and increasing potency: Dehydroepiandrosterone sulfate (DHEAS), D4-Androstenedione (D4A), Testosterone (TESTO), dihydrotestosterone, play a key role in controlling ovarian function through the biosynthesis of estrogen as well as directly through the androgen receptor of the ovaries. The aim of this study is to evaluate the relationship between the levels of androgens DHEAS, TESTO and D4A, free androgen index (FAI), and sex hormone binding globin (SHBG) according to age of women, BMI and medication.
Materials and Methods
The subjects were women who visited the Laboratory of Aretaeio Hospital from 2007 to 2012, excluding those with known pathology (such as kidney disease, polycystic ovary syndrome, etc.). 2581 samples from 1524 women were selected. The concentration of DHEAS was measured by ECLIA electroluminescence immunoassay and TESTO by the CMIA method. ECLIA method was performed to measure the SHBG levels while the FAI values were calculated by the formula:
FAI = Testo (ng/mL) * 347 / SHBG (nmol/L).
The concentration of D4A was measured by the ELISA method using the DiaMetra ELISA kit.
Results
The results of the study indicate that levels of most androgens are associated with age. There is a significant correlation between DHEAS levels and age, with the two values being inversely proportional, from (Median, IQR) 287 μg/dL (145-561) at 17-21.9 years to 68.5 μg/dL (22,3-111) at 67-71.9 years. The relationship between DHEAS levels and age is given by the form of the equation below:
DHEAS (μg/dL) = 417,292 - 5,548 *Age (years) (r = -0731; p <0.001).
TESTO levels also significantly decrease with age, from (Median, IQR) 0.76 ng/mL (0.35-1.39) at 17-21.9 years to 0.38 ng/mL (0.14-0.80) at 67-71.9 years. The form of the equation is: TESTO (ng/mL) = 0.933 - 0.009 * Age (years) (r = -0.484; p <0.001).
The same statistically significant downward trend in levels of D4A as age increases: from 307 ng/dL (135-558) at 17-21.9 years, to 80 ng/dL (26-162) at 67-71.9 years. The form of the equation is: D4Α (ng/dL)= 426,224 - 5,467 * Age (years) (r = -0,693; p <0.001). SHBG levels remain relatively stable at around 60 nmol/L (23.3-123.6), with the form correlating the two parameters to be: SHBG (nmol / L) = 44,662 + 0,415 * Age (years) (r = 0,180; p <0.001). Finally, FAI decreases steadily as age increases from 6.0 (1.3-14.4) at 17-21.9 years to 2.0 (0.6-4.8) at 67-71.9 years. The correlation is given by the equation: FAI = 6,750 - 0.080 * Age (years) (r = -0.517; p <0.001).
Regarding the relationship between androgen levels and BMI, DHEAS is weakly related to ΒΜΙ, and only when age is added as an additional correlation factor the relationship is improved and which is given as follows: DHEAS (μg/dL) = 260.248 + 0.869 * BMI (kg/m2) - 3.218 * AGE (years) (r = 0.370; p <0.001). On the other hand, SHBG levels decrease as BMI increases. The ratio between the two parameters:
SHBG (nmol/L) = 154,429 - 3,101 * BMI (kg/m2) (r = 0.176; p <0.001). The correlation gets stronger when age is taken into consideration and is as follows: SHBG (nmol/L) = 135,506 - 3,141 * BMI (kg/m2) - 0,358 * AGE (years) (r = 0,426; p <0.001). TESTO shows only a weak correlation with BMI. So do D4 androstenedione and FAI levels.
Finally, the study examines whether the levels of androgens are affected by medication. DHEAS levels appear much higher when receiving medication other than hormone replacement therapy (HRT). SHBG levels are not affected by any type of medication but they seem to reduce when HRT is received. D4 androstenedione levels are affected by HRT uptake and increase. TESTO levels are not affected by any kind of medication while FAI levels are reduced when HRT is received.
Conclusion
The results of the study seem to be comparable to those of the international literature. They can also contribute to improving the health of women through the consult the results of reference range values of androgens by age. This can lead to an early diagnosis of hyperandrogenemia and syndromes or diseases related in order to response immediately to that.
Keywords:
Androgens, Age, Woman, Reference range, BMI, Hormone treatment
