Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries

Thirty-one patients with clinical features of polycystic ovary syndrome (PCO) were studied to determine the correlation between biochemical and histologic findings. The biochemical features investigated were the effects of adrenocortical and ovarian suppression by dexamethasone and oral contraceptives (Ovulen) on plasma free androgens. Four patients showed a histologic picture consistent with PCO (Group A), and five had histologically normal ovaries (Group B). The remaining 22 patients had no tissue available for histologic examination (Group C). The baseline values of plasma free testosterone (FTel) were higher and those of testosterone-binding globulin (TeBG) were lower (p less than 0.05) in Group A than in Group B, although plasma total testosterone (T) and the free 17beta-hydroxysteroid androgen index (FHSl) were similar in the two groups. During dexamethasone administration in all study groups, T and FTel fell slightly (17.7% to 33.8%), and FHSl levels decreased moderately (36% to 46.6%); in no case did both indices of free androgen levels fall to the normal range for dexamethasone-suppressed women. However, no change was noted in TeBG in all three groups. On the other hand, Ovulen treatment suppressed T and free androgens to normal in all groups, and raised TeBG more than 350% from the baseline. These data suggest a decrease in androgen production. The effects of dexamethasone and Ovulen on all three groups were similar in percent changes. As Group B patients resemble those of Group A biochemically and clinically, except for possibly being less hyperandrogenic, the concept of ovarian hyperandrogenism should be expanded to include patients with no anatomic ovarian abnormality, particularly in milder cases.