MILD ADRENAL AND OVARIAN STEROIDOGENIC ABNORMALITIES IN HIRSUTE WOMENWITHOUT HYPERANDROGENEMIA - DOES IDIOPATHIC HIRSUTISM EXIST

To study ovarian and adrenal steroid profiles of women with idiopathic hirsutism, we compared sex steroid and basal and corticotropin (ACTH) -stimulated adrenal steroid levels before and after ovarian suppressio n induced by a long-acting gonadotropin releasing hormone agonist anal og (GnRH-a) in 24 hirsute women without hyperandrogenemia. Twelve heal thy women served as controls for basal and ACTH-stimulated adrenal ste roid levels. Serum levels of testosterone (T), sex hormone-binding glo bulin (SHBG), estradiol (E-2), basal and ACTH-stimulated 17-hydroxypro gesterone (17OHP), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS) , Delta(4)-androstenedione (Delta(4)-A), 11-deoxycortisol (S) and cort isol (F), and basal and luteinizing hormone-releasing hormone (LNRH)-s timulated gonadotropin levels were measured before and 21 days after 3 .75 mg intramuscular triptorelin in hirsute women. Basal T levels and basal and ACTH-stimulated Delta(4)-A, DHEA, and DHEAS levels were not different in hirsute women with respect to controls. Basal and ACTH-st imulated 17OHP was elevated, and decreased to normal after ovarian sup pression with triptorelin. Although basal and ACTH-stimulated Delta(4) -A levels were normal, the Delta Delta(4)-A/Delta F and Delta Delta(4) -A/Delta 17OHP ratios were elevated and remained elevated after ovaria n suppression, suggesting enhanced adrenal Delta(4)-17,20-lyase activi ty. T, F, S, and DHEAS levels were not affected by ovarian suppression . Basal and ACTH-stimulated 17OHP and Delta(4)-A, and stimulated DHEA concentrations were reduced with ovarian suppression, but their net in crement and ratio to the increase of F in response to ACTH remained un changed, reflecting the ovarian contribution to the secretion of these steroids. We conclude that idiopathic hirsute women with normoandroge nemia show an increase in ovarian secretion of 17OHP and a minimally i ncreased adrenal Delta(4)-17,20-lyase activity, suggesting that mild f orms of ovarian and adrenal functional hyperandrogenism may be present in these patients with otherwise unexplained hirsutism. Copyright (C) 1997 by W.B. Saunders Company.