The etiology of hyperandrogenism in women.

This review considers recent evidence which has implicated steroidogenic alterations as elements on the etiology of the androgen excess associated with polycystic ovary syndrome. The importance of circulating dehydroepiandrosterone sulphate as a precursor for ovarian follicular testosterone is discussed and evaluated in the face of indications that the activity of P450-c17-alpha-hydroxylase is altered at both adrenal and ovarian level in polycystic ovary syndrome. The impact of weight and insulin resistance on circulating dehydroepiandrosterone concentrations is discussed, and related to the endocrine changes in polycystic ovary syndrome. Androgen excess in women arises from multiple endocrine disturbances, which evidently commonly include the steroidogenic pathways.