Comparison of adrenocortical steroidogenesis in women with post‐adolescent severe acne and polycystic ovary syndrome

Abstract

Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear. We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women. The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age 17-34years, BMI: 20.8±1.9kg/m²). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation. T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P<0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P<0.05). Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway.