Postmenopausal hyperandrogenism can be due to excessive androgen secretion from adrenal or ovarian virilising tumours or non-neoplastic conditions. The aetiology of postmenopausal hyperandrogenism can be difficult to discern because of limited accuracy of current diagnostic tests. This systematic review compares the diagnostic accuracy of the GnRH analogue stimulation test against selective ovarian and adrenal vein sampling of androgens in distinguishing neoplastic from non-neoplastic causes of postmenopausal hyperandrogenism. 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. The summary sensitivity of the GnRH analogue stimulation test is 10% (95% CI 1.1 – 46.7%) and that for selective venous sampling is 100% (95% CI 0 – 100%). Both tests have 100% specificity. There is limited evidence for the use of either test in identifying virilising tumours in postmenopausal hyperandrogenism.

Spinal cord infarction may present as longitudinally extensive myelopathy, similar to inflammatory myelitis such as neuromyelitis optica. Magnetic resonance imaging features such as diffusion‐weighted imaging/apparent diffusion coefficient showing restricted diffusion and lack of contrast enhancement are helpful in the diagnosis of spinal cord infarction and differentiating them from inflammatory myelitis.