Ovarian and adrenal hyperandrogenism

Area of Science:

• Endocrinology
• Reproductive Medicine
• Metabolic Disorders

Background:

• Distinguishing androgen sources (ovarian vs. adrenal) has historically been challenging.
• Dynamic testing limitations led to decreased focus on specific androgen sources for hyperandrogenism diagnosis.
• Understanding androgen excess origins remains vital for classification and knowledge advancement.

Purpose of the Study:

• To review the primary sources of androgen excess in Polycystic Ovary Syndrome (PCOS), idiopathic hyperandrogenism, and nonclassic 21-hydroxylase deficiency (NCAH).
• To explore the prevalence of multi-glandular androgen secretion in these common hyperandrogenic disorders.
• To investigate the contributing factors to adrenal hyperandrogenism in PCOS and idiopathic hyperandrogenism.

Main Methods:

• Literature review focusing on the etiology of androgen excess in common hyperandrogenic syndromes.
• Analysis of studies differentiating ovarian and adrenal androgen production.
• Examination of factors contributing to adrenal hyperandrogenism in PCOS and idiopathic hyperandrogenism.

Main Results:

• The ovary is the main androgen source in PCOS and idiopathic hyperandrogenism; adrenal secretion predominates in NCAH.
• Mixed androgen secretion is frequent: 70-80% in NCAH, 35% in PCOS, and 50% in idiopathic hyperandrogenism.
• Adrenal hyperandrogenism in PCOS/idiopathic cases is linked to hyperinsulinemia, altered cortisol metabolism, and increased ovarian steroid production.

Conclusions:

• The ovary is the primary source of excess androgens in PCOS and idiopathic hyperandrogenism, while the adrenal gland is primary in NCAH.
• Multiple androgen sources are common in all major hyperandrogenic disorders.
• Increased dehydroepiandrosterone sulfate (DHEAS) in hyperandrogenic patients correlates with lower weight, insulin levels, and improved metabolic profiles.