Prevalence of 21-hydroxylase-deficient nonclassic adrenal hyperplasia and insulin resistance among hirsute women from Puerto Rico

Objective: To determine the prevalence of 21-hydroxylase (21-OH)-deficient nonclassic adrenal hyperplasia (NCAH) and insulin resistance in hirsute wom en from Puerto Rico. Design: Cross-sectional prospective study. Setting: Clinical research center. Patient(s): 100 consecutive untreated hirsute women. Main Outcome Measure(s): Fasting total T, free T, DHEAS, insulin, and gluco se were measured, and a 60-minute acute ACTH-(1-24) stimulation for 17-hydr oxyprogesterone (17-HP) was performed. A diagnosis of 21-OH-deficient NCAH was considered when the stimulate 17-HP level was >30.3 nmol/L. The glucose /insulin ratio was calculated as a measure of insulin resistance (normal va lue, greater than or equal to 4.5). Result(s): Patients had a mean (+/-SD) age of 26.8 +/- 6.6 years; 82 were o ligomenorrheic. Overall, 12%, 8% and 60% of patients had elevated levels of DHEAS, total T, or free T, respectively. One patient was identified as hav ing 21-OH-deficient NCAH. Eight women, none of whom had NCAH, were found to be hyperglycemic; four of these women had type 2 diabetes mellitus. Exclud ing hyperglycemic patients, a glucose/insulin ratio of <4.5, consistent wit h IR, was found in 51.7%. Conclusion(s): The prevalence of 21-OH-deficient NCAH among patients from P uerto Rico does not differ significantly from that reported for other non-J ewish, non-Hispanic white populations. (Fertil Steril(R) 2000;74:59-62. (C) 2000 by American Society for Reproductive Medicine).