Ovarian-adrenal cross-talk in polycystic ovary syndrome: evidence from wedge resection

Objective: To determine whether the ovary influences adrenal androgen secre tion in women with polycystic ovary syndrome (PCOS). Design: Six PCOS-affected patients with clomiphene resistance and gonadotro phin hyperresponsivity, and six controls with regular ovulatory cycles, mat ched for age and body mass index. Methods: Bilateral ovarian wedge resection was performed to induce ovulatio n surgically for these refractory women with PCOS. The adrenal androgen sec retions were evaluated in PCOS patients before and again 6 months after thi s surgery, and in the controls, using an ACTH stimulation test (0.25 mg syn thetic ACTH(1-24)). Results: Biochemically, basal levels and the maximum net increases (Delta) of 17-hydroxyprogesterone (17-OHP) and androstenedione, Delta 17-OHP/Delta progesterone and Delta androstenedione/Delta 17-OHP ratios in response to e xogenous ACTH were significantly higher in PCOS patients before operation t han those of controls. This purely ovarian surgery in women with PCOS was f ound to significantly reduce their basal androstenedione, testosterone and LH levels, insulin/glucose ratio, and post-corticotrophic Delta 17-OHP, Del ta androstenedione, Delta 17-OHP/Delta progesterone and Delta androstenedio ne/Delta 17-OHP, without obvious changes in FSH, oestradiol, sex hormone-bi nding globulin, Delta dehydroepiandrosterone, Delta dehydroepiandrosterone sulphate, Delta aldosterone and Delta cortisol values. Conclusions: Ovarian hyperandrogenicity from polycystic ovary may contribut e to the enhanced adrenal P450c17 alpha activity and subsequent Delta(4) an drogen reserve revealed by the pharmacological corticotrophin stimulation i n our special PCOS cases.