[Tests of adrenal gland and ovarian function in the hyperandrogenemia syndrome]

Androgen production in women is under the influence of pituitary hormones on ovaries and adrenal glands, or they originate from peripheral conversion of androgen precursor. Each of the three principal compartments of androgen production has a serum specific marker that may be clinically helpful. Serum testosterone signifies ovarian production, dehydroepiandrosterone sulfate (DHA-S) is an adrenal marker, and serum 3 alpha-diol glucuronide reflects androgen action in the peripheral compartment. Many physiologic and pathologic states affect transport proteins and enzyme systems which modulate androgenic activity. This fact makes the determination of mechanism and origin of hyperandrogenemia more difficult, as well as the choice of therapy. In the syndrome of hyperandrogenemia, the primary place of the disorder is determined by the tests of adrenal cortex and ovary functions. The correct response of androgens in dexamethasone test is manifested by free testosterone suppression to < 0.028 nmol/L, and by DHA-S and plasma cortisol suppression under the reference values. In the complex and controversial syndrome of hyperandrogenemia, the nafarelin test is used after insufficient free testosterone suppression in dexamethasone test. The significant diagnostic criterion is the rise of 17-hydroxyprogesterone (17-OHP) over 7 nmol/L, which aligns a great number of idiopathic hyperandrogenemias in the group of polycystic ovary syndrome. A good correlation was found between the rise of 17-OHP in nafarelin test and the suppression of free testosterone in dexamethasone test. This finding supports the conception that both tests determine the ovary function and that their sensitivity and specificity for ovary hyperandrogenemia is comparable.