[Polycystic ovary--classification and treatment by bromocriptine]

Plasma levels of androstenedione (A) and dehydroepiandrosterone sulfate (DHAS) were measured in 29 women with PCO in an attempt to classify PCO. A and/or DHAS were elevated in all cases. In cases with DHAS levels below 2,000 ng/ml, the A levels were found to be over 1.4 ng/ml. This group was defined as an ovarian type because the major source of A is the ovary. In contrast, women whose DHAS levels were higher than 2,000 ng/ml were classified as an adrenal type. In both groups, the hormonal features were elevated LH levels and exaggerated LH response to LHRH. The mean A levels were 2.43 +/- 0.31 ng/ml in ovarian type and 2.20 +/- 0.42 ng/ml in adrenal type. The mean DHAS levels for the adrenal type were 3,052 +/- 299 ng/ml, or about 3 times as high as normal values. On the other hand, those for the ovarian type were on the upper borderline of the normal range. In both groups, dexamethasone lowered DHAS levels by about 80% with no discernible effect upon A levels. The successful rate for ovulation-induction by clomiphene was 20% in the ovarian and 33% in the adrenal. Bromocriptine induced ovulation in 8 out of 9 cases of the ovarian type. However, only one of 6 responded to bromocriptine in the adrenal type. Bromocriptine-unresponsive cases of the adrenal type ovulated following treatment with combination of clomiphene and prednisolone. In summary, we attempted to classify PCO into ovarian and adrenal types by analyzing the elevated androgen level. This classification seems to be useful in the treatment of PCO and also provides some insight into the pathogenesis of PCO.