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Lack of an ovarian function influence on the increased adrenal androgen secretion present in women with functional
H F Escobar-Morreale1, J Serrano-Gotarredona, R García-Robles
1Department of Endocrinology, Hospital Ramón y Cajal, Madrid, Spain. hescobar@mvax.fmed.uam.es
Objective:
To evaluate whether ovarian function might have an influence on the adrenal hyperandrogenism present in patients with functional ovarian hyperandrogenism.
Design:
Controlled clinical study.
Setting:
Tertiary institutional hospital.
Patient(S):
Twenty-nine hirsute women with functional ovarian hyperandrogenism and 12 normal controls.
Intervention(S):
The ACTH and GnRH tests were performed before and during triptorelin-induced ovarian suppression in patients. The normal women served as controls for the ACTH test.
Main Outcome Measure(S):
Basal and ACTH-stimulated steroid values.
Result(S):
All patients presented elevated T and free androgen index, which normalized after triptorelin. Patients with functional ovarian hyperandrogenism and adrenal hyperandrogenism, defined by elevated basal DHEAS (n = 10), presented enhanced delta 4-17, 20-lyase activity, which persisted during ovarian suppression. delta 4-17,20-lyase activity was normal in the functional ovarian hyperandrogenism patients without adrenal hyperandrogenism (n = 19). No correlation was observed between the any of the indexes of the adrenal enzymatic activities evaluated and plasma E2 or T.
Conclusion(S):
Increased adrenal delta 4-17,20-lyase activity is present in functional ovarian hyperandrogenism women with adrenal hyperandrogenism. No influence of the excess ovarian androgens or estrogens was found on any of the adrenal enzymatic pathways explored.