Classification of polycystic ovary syndrome into three types according to response to human corticotropin-releasing hormone

Abstract

Objective: To evaluate disturbances of the hypothalamic-pituitary-adrenal axis in women with polycystic ovary syndrome (PCOS). Design: Retrospective cohort study. Setting: Yokohama City University, Yokohama, Japan. Patient(s): Sixty women with PCOS and 19 women with normal menstruation. Intervention(s): Administration of human corticotropin-releasing hormone (hCRH), dexamethasone suppression testing, and stimulation of ovulation with clomiphene citrate. Main Outcome Measure(s): Plasma cortisol and ACTH levels, plasma androstenedione and DHEAS levels, and ovulation rates. Result(s): In women with PCOS, plasma ACTH and cortisol levels were significantly higher and the plasma ACTH level after the administration of hCRH was higher than in controls. Based on the response to hCRH, patients with PCOS could be classified into three categories: those with a normal response to hCRH (group 1), those with an exaggerated response of ACTH to hCRH (group 2), and those with a high basal level of cortisol and a poor response to hCRH (group 3). In groups 2 and 3, DHEAS levels were significantly higher, suppression of androstenedione by dexamethasone was significantly greater, and ovulation rates with clomiphene citrate were significantly lower than in group 1. Conclusion(s): This classification provides insight into the underlying cause of PCOS and thus is useful in selecting appropriate treatment.