Ovarian influence on adrenal androgen secretion in polycystic ovary syndrome.

OBJECTIVE

To determine whether the ovary influences adrenal androgen secretion in polycystic ovary syndrome (PCOS).

DESIGN

The adrenal androgen secretion was evaluated before and during ovarian suppression with a long-acting GnRH agonist.

SETTING

Department of Obstetrics and Gynecology, Pisa, Italy.

PARTICIPANTS

Women with PCOS and high (10 subjects) and normal (12 subjects) DHEAS levels and 6 normal women.

INTERVENTIONS: After 1 mg dexamethasone, an ACTH-(1-24) stimulation test was performed in the early follicular phase of the menstrual cycle. The test was repeated after two injections of a long-acting GnRH analogue (GnRH-a).

MAIN OUTCOME MEASURES: Basal plasma levels of gonadotropins, E2, T, androstenedione (A), 17 alpha-hydroxyprogesterone (17-OHP), DHEAS, and cortisol (F) were evaluated before the evening administration of dexamethasone. Serum A, T, 17-OHP, DHEAS, and F were measured 9 hours after dexamethasone and in samples collected 60 and 120 minutes after ACTH IV injection.

RESULTS

In the high DHEAS group the maximum increases in T, A, 17-OHP, and DHEAS in response to ACTH were significantly higher than in normal DHEAS PCOS women and in normal women. The GnRH-a modified the A and T responses to ACTH in the high DHEAS group.

CONCLUSIONS

Ovarian steroids, or other extra-ovarian factors, seem to be responsible for the increased A and T responses to the corticotropin stimulation demonstrated in some PCOS women.