CHARACTERIZATION OF 24-H CORTISOL RELEASE IN OBESE AND NONOBESE HYPERANDROGENIC WOMEN

Excessive androgen output is a well-recognized feature of adrenocortic al oversecretion in women with ovarian hyperandrogenism or polycystic ovary disease (PCOD). However, evidence of a concomitant alteration of cortisol secretion is lacking even though obesity per se, a common cl inical feature of PCOD, has been shown to be associated with cortisol oversecretion. To clarify whether a subtle alteration in cortisol secr etion exists, a study of 24-h episodic cortisol release and post-prand ial cortisol responses was undertaken in eight women with PCOD and eig ht normal women comprising equal numbers of obese and non-obese subjec ts. All four groups showed normal biphasic 24-h cortisol secretion pro files but cortisol pulse frequency was increased in the PCOD groups. I ndependently, both hyperandrogenism and obesity were associated with a n accelerated cortisol clearance rate. These changes, together with no rmal or only slightly elevated 24-h cortisol integrated area under the curve, suggest an increased compensatory cortisol production in women with PCOD. Furthermore, subjects with PCOD and subjects with obesity showed different post-prandial cortisol responses to normal non-obese women. In conclusion, these subtle cortisol abnormalities may be a man ifestation of altered central regulation of the hypothalamic-pituitary -adrenal axis and peripheral metabolic abnormalities, and may be linke d to the pathophysiology of PCOD.