436 THE ROLE OF ADRENAL STEROIDS IN PSEUDOPRECOCIOUS PUBERTY DUE TO LARGE OVARIAN FOLLICULAR CYSTS

Abstract

Ovarian secretion of trophic steroids, or their precursors, such as 17-hydroxyprogesterone (17P), increases during puberty. Many of these steroids are also secreted by the adrenal. We have shown that girls with premature adrenarche have increased 17P levels after ACTH stimulation. In order to study the role of adrenal androgens in other forms of precocious puberty, we measured 17P after dexamethasone (DEX) suppression (lmg) and an IV bolus of ACTH (0.25 mg) in 5 girls with premature thelarche who also had small ovarian cysts documented by ultrasound (PT) and 2 girls with pseudoprecocious puberty due to a large follicular ovarian cyst (PP). The girls with PT had normal 17P levels which were suppressed completely after DEX and increased to 61±16(X±SD) ng/dl after ACTH (normal 71±20ng/dl). Although basal 17P levels were normal in the girls with PP, they were not completely suppressed by DEX and increased to levels over 3-times normal after ACTH (360, 540, ng/dl). Excision of the cysts abolished pubertal progression and restored DEX suppressibility of 17P. Although the 17P responses to ACTH were substantially decreased (160, 350 ng/dl), they were still supranormal. Suggestion: Excess steroid production by the adrenal may stimulate development of small ovarian cysts into large cysts and thus cause PP.