DIFFERENT DYSREGULATIONS IN ADRENAL-STEROID BIOSYNTHESIS AS A PREVALENT CAUSE OF HYPERANDROGENISM IN WOMEN FROM SOUTHERN ITALY

Objective: To investigate the presence of a dysregulation in steroid b iosynthesis in women from southern Italy. Design: Controlled clinical study. Setting: Normal and hyperandrogenic women referred to the Endoc rinology Unit of Federico II University Medical School of Naples. Pati ent(s): One hundred fifty untreated young hyperandrogenic women and 50 normal age-matched women. Intervention(s): Morning (basal) blood samp les obtained in the early follicular phase and after a long (360 minut e) ACTH stimulation test. Main Outcome Measure(s): The adrenal maximal response was calculated as stimulus under curve areas (AUC(s)), and a ll steroids were assayed using RIA methods. Result(s): A dysregulation of 21-hydroxylase was found in 22 patients (14.7%), with a prevalent increase of 17 alpha-hydroxyprogesterone AUC, whereas in 9 hirsute wom en (6%), there was a prevalent significant increase in 11-deoxycortiso l AUC. In 5 women (3.3%), DHEA and DHEAS basal and AUCs plasma levels were increased, suggesting an impaired 3 beta-olo-dehydrogenase activi ty. The remaining 114 hyperandrogenic women (76%) compose the nonadren al group, with a probable diagnosis of primitive functional ovarian hy perandrogenism. Conclusion(s): Considering the high prevalence of hirs utism and oligomenorrhea in our female hyperandrogenic population, we suggest an adrenal hyperresponsiveness likely due to a dysregulation i n enzymes related to androgen adrenal steroidogenesis. (C) 1997 by Ame rican Society for Reproductive Medicine.