Dexamethasone-suppression adrenal scintigraphy in hyperandrogenism: concise communication

Area of Science:

• Endocrinology
• Nuclear Medicine
• Reproductive Medicine

Background:

• Hirsutism in women is often linked to hyperandrogenism.
• The adrenal cortex can be a significant source of androgens contributing to hirsutism.
• Accurate diagnosis is crucial for effective management of hyperandrogenic conditions.

Purpose of the Study:

• To evaluate the role of adrenal-derived androgens in women experiencing hirsutism.
• To assess the utility of dexamethasone suppression (DS) adrenal scintigraphy in identifying androgen sources.
• To differentiate between normal adrenal function and abnormal androgen production in hirsute women.

Main Methods:

• Thirty-five women with hirsutism underwent adrenal scintigraphy using 6 beta-[131I]iodomethylnorcholesterol.
• Dexamethasone suppression (DS) regimens (8 mg/d for 2 days or 4 mg/d for 7 days) were employed prior to imaging.
• Imaging patterns were analyzed, and adrenal-vein catheterization was performed in select cases to measure testosterone levels.

Main Results:

• Three distinct imaging patterns emerged: normal uptake, bilateral early visualization, and unilateral early visualization.
• Bilateral early visualization, seen in 13 patients, correlated with elevated adrenal-vein testosterone.
• Unilateral early visualization, observed in five patients, was often associated with adrenocortical adenomas.

Conclusions:

• The adrenal cortex is confirmed as a key source of androgens in women with hirsutism and hyperandrogenism.
• Dexamethasone suppression adrenal scintigraphy is a valuable tool for identifying patients with adrenal contributions to hyperandrogenism.
• This imaging technique aids in diagnosing the etiology of hirsutism and guiding therapeutic decisions.