Clinical and hormonal studies in hyperthecosis of the ovaries

Endocrine studies were performed in five women with ovarian hyperthecosis. Measurement of testosterone (T), dihydrotestosterone (DHT), androstenedione (A), 17 alpha-hydroxyprogesterone (17-OHP), progesterone (P), estradiol (E2), and estrone (E1) in the peripheral and ovarian vein serum obtained simultaneously at the time of surgery indicated that the hyperthecotic ovaries secreted large amounts of potent androgens T and DHT. There was a less marked increase in A secretion. Peripheral P and 17-OHP levels were elevated, with a significant peripheral ovarian gradient. E1 comes entirely from peripheral conversion, while at least a portion of E2 comes from direct secretion from the ovaries. Circulating FSH and LH levels were low or normal. The gonadotropin response to LH-RH was in the normal range. No patient ovulated with Clomid treatment. The hirsutism did not improve with ovarian suppression with birth control pills, possibly because of the absence of tonic elevation of LH. The hypothalamic pituitary physiology in hyperthecosis is different from that in polycystic ovarian disease.