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In Reply: In response to Dr Willenberg and colleagues, the Rotterdam criteria¹ (and the preceding National Institutes of Health-National Institute of Child Health and Human Development criteria²) only recommend excluding congenital adrenal hyperplasia and androgen-secreting tumors (possibly in the adrenal), not adrenal hyperandrogenism per se. The reason for this is that both adrenal and ovarian hyperandrogenism are common in women with PCOS and are most likely indicative of some underlying disorder in steroidogenesis.³

I agree that the corticotropin stimulation test is the criterion standard to diagnose late-onset congenital adrenal hyperplasia, but disagree that the measures of basal concentrations of 17-OHP are uninformative to screen for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. In a prospective study, a cutoff level of 4 ng/mL for 17-OHP had maximum specificity and positive predictive value, with little loss in sensitivity, assuming testing is performed in the morning and during the follicular phase (which . . . [Full Text of this Article]

Richard S. Legro, MD
rsl1@psu.edu
Department of Obstetrics and Gynecology
Pennsylvania State University College of Medicine
Hershey