A practical dexamethasone suppression test to evaluate hirsute women

Area of Science:

• Endocrinology
• Reproductive Medicine
• Clinical Investigation

Background:

• Hirsutism in women is often linked to androgen excess.
• Identifying the specific source of excess androgens (ovarian vs. adrenal) is crucial for effective treatment.
• The dexamethasone suppression test is a standard method for evaluating adrenal androgen production.

Purpose of the Study:

• To determine the primary source of androgen excess in a cohort of hirsute women.
• To assess the utility of the dexamethasone suppression test in differentiating between adrenal and ovarian androgen overproduction.

Main Methods:

• Fifty-five hirsute women underwent a 2-week dexamethasone suppression test.
• Plasma dehydro-epiandrosterone-sulfate (DS) and testosterone (T) levels were measured pre- and post-dexamethasone via radioimmunoassay.
• Adrenal suppression adequacy was confirmed, and androgen sources were categorized.

Main Results:

• Adequate adrenal suppression was achieved in 51 out of 55 patients.
• The source of androgen excess was identified in 94% of these patients.
• Ovarian sources accounted for 33%, adrenal sources for 26%, and mixed adrenal-ovarian sources for 35% of cases.
• Even with normal baseline DS and T levels, adrenal androgen excess was suggested in some cases.

Conclusions:

• The source of androgen excess in hirsute women is distributed relatively equally among ovarian, adrenal, and mixed origins.
• The dexamethasone suppression test is effective in defining androgen excess sources in most hirsute women.
• Further investigation may be needed for cases with normal baseline androgen levels but clinical hirsutism.