Hirsutism: diagnostic approach and stimulation-suppression dynamics of androgens in the female

Total 24-hour urinary 17-ketosteroid (17-KS) and serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured before and after the administration of Cortrosyn and dexamethasone in 46 hirsute and 18 nonhirsute women. Both the baseline urinary 17-KSs and serum androgen levels were significantly higher (P less than 0.05) in hirsute than in nonhirsute subjects. In 58% of the patients in the hirsute group serum androgen concentrations were found to be elevated, while 17-KS levels in 24-hour urine collections were within normal limits. In 87% of our hirsute subjects at least one serum androgen was elevated. Serum DHEA-S concentration was elevated in almost half of the patients with hirsutism. For the evaluation of hyperandrogenism, measurements of serum androgens give more accurate information to the clinician. Dynamic stimulation-suppression studies do not appear to offer any better understanding of the type of androgens involved or a rational guide to the choice of therapy. Hirsute patients were found to be responding less to corticotropin stimulation in comparison to nonhirsute patients. The stimulation rate was significantly higher in 17-KS, A, T, and DHEA-S concentrations in nonhirsute than in hirsute patients.