OVARIAN SUPPRESSION WITH TRIPTORELIN AND ADRENAL STIMULATION WITH ADRENOCORTICOTROPIN IN FUNCTIONAL HYPERANDROGENISM - ROLE OF ADRENAL AND OVARIAN CYTOCHROME P450C17-ALPHA

Objectives: To validate combined ovarian suppression with triptorelin and adrenal stimulation with ACTH in the diagnosis of female hyperandr ogenism and to provide new insights into the adrenal-ovarian relations hip present in this disorder. Design: Comparison of sexual steroids an d basal and ACTH-stimulated steroid levels before and after ovarian su ppression induced by triptorelin. Setting: Department of Endocrinology , Hospital Ramon y Cajal, Madrid, Spain. Participants: Thirty-nine non selected women with hyperandrogenism. Main Outcome Measures: Serum lev els of T, 17-hydroxyprogesterone (17-OHP), 17-hydroxypregnenolone, DHE A and DHEAS, androstenedione (Delta(4)-A), 11-deoxycortisol, and corti sol. Results: Elevated T independent of ovarian suppression pointed to an adrenal disorder in six patients (one with an androgen-producing a denoma, two with late-onset 21-hydroxylase deficiency, three with func tional adrenal hyperandrogenism). Nineteen patients had functional ova rian hyperandrogenism as elevated T normalized after ovarian suppressi on acid were subdivided into ovDHEAS+ (n = 7) and ovDHEAS= (n = 12) su bgroups depending on the presence of DHEAS hypersecretion. Finally, 14 patients had idiopathic hirsutism according to normal T before and af ter ovarian suppression. Comparisons of initial hormonal values betwee n groups and with reference values obtained from normal women (n = 11) disclosed in functional adrenal hyperandrogenism an elevation of T an d basal and stimulated DHEAS, Delta(4)-A, and 17-OHP with respect to n ormal women. These abnormalities were also present in ovDHEASt+ except for basal Delta(4)-A, which was normal, whereas only T and stimulated 17-OHP were elevated in ovDHEAS=. In the idiopathic group all steroid s were normal with the exception of a mild elevation in stimulated DHE AS. Conclusions: These results show a continuum of abnormalities in hy perandrogenic women, suggesting an enhanced cytochrome P450c17 alpha a ctivity in the adrenal and the ovary as the shared mechanism between f unctional adrenal hyperandrogenism and functional ovarian hyperadrogen ism.