Steroid hormone levels in serum and skin receptor concentrations in hirsutism

In 36 women androgen (AR), estrogen (ER) and progesterone (PgR) receptor were determined by dextran coated charcoal assay and subsequent Scatchard plot analysis in skin slices obtained from hirsute areas under local anesthesia. The biopsies were performed between day 18-21 of the menstrual cycle. Concomitantly venous blood was sampled in these and additional 14 patients for radioimmunoassay estimation of serum levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), androstenedione (A), estradiol (E2) and prolactin (PRL). However, it should be noted that all receptors and hormones were not examined in all patients. The incidence of ER-positive patients was smaller (i.e. 17%) than previous findings in acne and normal skin, while 26% of the examined patients were AR-positive. This result was similar to findings in acne, whereas the receptor levels are three times higher than in acne lesions. This suggests a greater androgen sensitivity of hirsute areas compared to acne lesions. Two out of 10 examined patients were PgR-positive. T was elevated in 63%, DHEA-S in 50% and A in 37% of examined patients. Lack of correlation between hormone serum levels and corresponding receptors concentration indicates a direct involvement of hormone action at the cellular level. The data combine to suggest that greater target organ sensitivity was responsible for hirsutism in those patients with normal androgen serum levels, while the absence of receptors in skin samples may characterize patients with idiopathic hirsutism.