ADRENAL STEROIDOGENESIS IS RELATED TO INSULIN IN HYPERANDROGENIC WOMEN

Objective: To evaluate ovarian and adrenal steroid secretion in women with severe hyperandrogenism. Design: A prospective study. Setting: Th e Gynecological Endocrine Research Unit of the University Central Hosp ital, Oulu, Finland. Patients: Thirteen obese, hirsute women with seve re hyperandrogenism. Interventions: Adrenocorticotropin hormone stimul ation and dexamethasone suppression tests and selective catheterizatio ns of the left ovarian and adrenal veins were performed. Main Outcome Measures: The concentrations of insulin, P, 17-hydroxyprogesterone (17 -OHP), androstenedione (A), T, DHEA, DHEAS, and cortisol were measured . Results: The secretory gradients of T and its precursors, P, 17-OHP, A, and DHEA in the selective catheterizations showed the adrenal to b e the main source of excessive steroid production in these patients. T he concentrations of P (r=0.82), 17-OHP (r=0.89), A (r=0.84), T (r=0.8 6), and cortisol (r=0.87) in the adrenal vein showed a strong correlat ion with insulin measured from the same samples. Conclusions: Excessiv e androgens were secreted mainly by the adrenals in these obese hyperi nsulinemic women. Correlation analyses suggested that insulin stimulat es adrenal androgen and cortisol secretion, which may constitute an im portant component of the pathogenetic mechanisms of hyperandrogenism a nd the polycystic ovary syndrome.