Alternate pathway 17,20-lyase enzyme activity in the adrenals is enhanced in patients with polycystic ovary syndrome

Objective: To assess the activity of the enzyme cytochrome P450c17 alpha in patients with polycystic ovary syndrome (PCOS). Design: Prospective clinical study. Setting: Outpatients at Erciyes University Medical School, Kayseri, Turkey. Patient(s): Twenty-eight women with PCOS aged 25.44 +/- 4.37 years (mean +/ - SD) and 18 normal women aged 26.94 +/- 3.17 years. Main Outcome Measure(s): Serum levels of 11-deoxycortisol, androstenedione (A), and 17 alpha-hydroxy progesterone were measured before and 30 and 60 m inutes after ACTH (0.25 mg IV) injection. Result(s): There was a statistically significant correlation between basal levels of 11-deoxycortisol (4.05 +/- 1.16 ng/mL) and A (3.36 +/- 0.97 ng/mL ) (r = 0.539). The peak level of 11-deoxycortisol (7.82 +/- 2.36 ng/mL) was also significantly correlated with the peak level of A (6.66 +/- 1.32 ng/m L) (r = 0.570) in women with PCOS. There was no statistically significant c orrelation between basal A (2.33 +/- 0.50 ng/mL) and basal 11-deoxycortisol (2.71 +/- 0.59 ng/mL) or between peak A (3.38 +/- 0.50 ng/mL) and peak 11- deoxycortisol (3.68 +/- 0.48 ng/mL) levels in control subjects. Conclusion(s): We believe that PCOS is characterized by enhanced activity o f 17,20-lyase enzyme in an alternate pathway between 11-deoxycortisol and A in the adrenal glands. (Fertil Steril(R) 1999;71:1075-8. (C) 1999 by Ameri can Society for Reproductive Medicine.).