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Related Experiment Videos

Androgens in Cushing's Syndrome.

Giorgio Arnaldi1, Marianna Martino2

  • 1Clinica di Endocrinologia e Malattie del Metabolismo, AOU Università Politecnica delle Marche, Ospedali Riuniti Ancona, Ancona, Italy, gioarnaldi@gmail.com.

Frontiers of Hormone Research
|September 10, 2019
PubMed
Summary

Screening for Cushing's Syndrome (CS) is crucial in women with polycystic ovary syndrome (PCOS) due to overlapping symptoms. Differentiating between CS and PCOS is vital for timely and accurate treatment of these androgen excess disorders.

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Area of Science:

  • Endocrinology
  • Reproductive Medicine

Background:

  • Polycystic ovary syndrome (PCOS) is the most common cause of androgen excess.
  • Cushing's Syndrome (CS) shares overlapping symptoms with PCOS, including menstrual abnormalities and hyperandrogenism.
  • Delayed diagnosis of CS can occur due to its similarity to PCOS.

Purpose of the Study:

  • To highlight the importance of screening for Cushing's Syndrome (CS) in women presenting with a polycystic ovary syndrome (PCOS) phenotype.
  • To discuss the diagnostic challenges in differentiating between CS and PCOS.
  • To emphasize the need for early and accurate diagnosis for appropriate treatment.

Main Methods:

  • Review of clinical presentations and diagnostic criteria for both PCOS and CS.
  • Analysis of hormonal profiles, including androgens and adrenocorticotropic hormone (ACTH).

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  • Evaluation of diagnostic utility of urinary steroid profiling using chromatography techniques.

    • Main Results:

    • Approximately 70-80% of women with CS exhibit menstrual abnormalities, and 46% show PCOS features.
    • ACTH-dependent CS often presents with elevated adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone-sulfate, androstenedione).
    • Adrenal androgens can be low in cortisol-secreting adenomas but elevated in androgen-secreting tumors; hyperandrogenism may persist in well-controlled CS due to compensatory ACTH response.

    Conclusions:

    • Screening for CS is recommended in women with PCOS phenotype, especially with additional risk factors like osteoporosis.
    • Accurate differentiation between CS and PCOS is essential to avoid missed or delayed CS diagnosis.
    • Advanced diagnostic methods like urinary steroid profiling show promise in managing these complex endocrine disorders.