Hypothalamic-pituitary-adrenal axis sensitivity to opioids in women with polycystic ovary syndrome

Objective: To evaluate the influence of the opioid system on the hypothalam ic-pituitary-adrenal axis in women with polycystic ovary syndrome (PCOS). Design: Controlled clinical study. Setting: Academic research environment. Patient(s): Eight lean and 12 obese women with PCOS, and seven lean and 5 o bese control subjects. Intervention(s): Each patient received an i.v. bolus of naloxone at a dose of 125 mu g per kilogram of body weight; 48 hours later, each patient recei ved 16 mg of loperamide p.o. Main Outcome Measure(s): Samples were collected for 2 hours for the naloxon e test and for 3 hours for the loperamide test. Levels of adrenocorticotrop ic hormone (ACTII) and cortisol were measured in all plasma samples. Result(s): The obese women with PCOS had a greater ACTII and cortisol respo nse to opiate blockade than either the lean women with PCOS or the control subjects, but there was no difference between the lean or obese control sub jects and the lean women with PCOS. There was no difference in the responsi veness of the hypothalamic-pituitary-adrenal axis to loperamide between the PCOS and control groups. Conclusion(s): The data indicate that the sensitivity of the hypothalamic-p ituitary-adrenal axis to opioids cannot be altered in women with PCOS. Howe ver, abnormalities of the hypothalamic-pituitary-adrenal axis in women with PCOS could be central in origin, as suggested by the effects of naloxone a dministration, and probably are related to the anthropometric characteristi cs of these hyperandrogenic patients.