Journal of Clinical Endocrinology & Metabolism, Vol 40, 988-1000, Copyright © 1975 by Endocrine Society

ARTICLES

Adrenal function in hirsutism I. Diurnal change and response of plasma androstenedione, testosterone, 17-hydroxyprogesterone, cortisol, LH and FSH to dexamethasone and 1/2 unit of ACTH

JR Givens, RN Andersen, JB Ragland, WL Wiser and ES Umstot

ACTH dependency of plasma androstenedione (A) and testosterone (T) was determined in normal and hirsute women by measuring the magnitude of change of A and T between the time of the cortisol (F) peak and F nadir in a diurnal study. There was a significant diurnal rhythm of A synchronous with F in both normal and hirsute women (P less than 0.01). Five of 12 hirsute women had a greater than normal diurnal swing of A (P less than 0.05), but only 2 of the 12 had a greater than normal diurnal swing of T. Responsiveness of A and T to 1/2 unit of intravenous ACTH was determined after dexamethasone 1 mg was given the night before. Plasma A and T were elevated in most of the hirsute women during acute ACTH suppression by dexamethasone, indicating ACTH- independent hypersecretion of androgens. Nine of 17 hirsute women had a greater than normal A response to ACTH (P less than 0.05). Those who had an exaggerated diurnal swing of A also had hyper-responsiveness of A secretion to ACTH. Only 2 hirsute women had an exaggerated T response to ACTH. Some T levels were decreased by ACTH. Seven of the 9 hiruste women who had an exaggerated A response to ACTH had a normal maximum F response, but a greater than normal 17-hydroxy-progesterone (17-OHP) response to ACTH with a high 17-OHP to F ratio, suggesting they have a mild but compensated reduction in 21-hydroxylase or 11beta-hydroxylase activity. Two women with hyper-responsiveness of A secretion had low F and 17-OHP responses to ACTH suggesting reduced C21 but intact C19 3beta-hydroxysteroid dehydrogenase-delta-5,-4 isomerase activity. These apparent reduced enzyme activity may not be congenital, but induced by an altered hormonal milieu such as an abnormal androgen-estrogen ratio. It is concluded that ACTH uniformly stimulated A secretion but not T secretion and that approximately 50% of the hirsute women had ACTH- dependent hypersecretion of A, but most of these also had concurrent ACTH-independent hypersecretion of androgens.

This article has been cited by other articles:

				T. Sir-Petermann, M. Maliqueo, B. Angel, H.E. Lara, F. Perez-Bravo, and S.E. Recabarren Maternal serum androgens in pregnant women with polycystic ovarian syndrome: possible implications in prenatal androgenization Hum. Reprod., October 1, 2002; 17(10): 2573 - 2579. [Abstract] [Full Text] [PDF]

				P. L. Chang, S. R. Lindheim, C. Lowre, M. Ferin, F. Gonzalez, L. Berglund, E. Carmina, M. V. Sauer, and R. A. Lobo Normal Ovulatory Women with Polycystic Ovaries Have Hyperandrogenic Pituitary-Ovarian Responses To Gonadotropin-Releasing Hormone-Agonist Testing J. Clin. Endocrinol. Metab., March 1, 2000; 85(3): 995 - 1000. [Abstract] [Full Text]

				A. Rodin, H. Thakkar, N. Taylor, and R. Clayton Hyperandrogenism in Polycystic Ovary Syndrome -- Evidence of Dysregulation of 11{beta}-Hydroxysteroid Dehydrogenase N. Engl. J. Med., February 17, 1994; 330(7): 460 - 465. [Abstract] [Full Text]

				M. M. Holmes, D. R. Rovner, A. S. Elstein, G. B. Holzman, M. L. Rothert, and M. M. Ravitch Factors Affecting Laboratory Utilization in Clinical Practice Med Decis Making, January 1, 1982; 2(4): 471 - 482. [PDF]