Urinary oestrogen excretion after metyrapone administration to patients with the polycystic ovary syndrome.

Abstract

SUMMARY The 24 hr. urinary excretion of oestrone, oestradiol and oestriol was measured during metyrapone administration in six normal women, four patients with primary amenorrhoea, six patients with polycystic ovary syndrome (POS) and three patients with secondary amenorrhoea. In the six normal women the oestrogen excretion on the first and second day of metyrapone administration did not differ from the control values except for a slight, probably significant, decrease in the excretion of oestradiol on the first day. In the patients with primary and secondary amenorrhoea the results were similar to those in the normal women. In the POS group the urinary excretion of oestrogens increased by 11–120% on the first day of metyrapone administration and by 63–140% on the second day. Studies with metyrapone in three patients with POS during dexamethasone suppression and/or ACTH administration suggest that the increased oestrogen excretion after metyrapone depended on the usual feedback mechanism between the adrenal and the hypothalamo-hypophysial system. Possible reasons for the absence of this increase in the normal subjects are discussed. It is concluded that the abnormal response to metyrapone in patients with the POS was not due to the amenorrhoea per se and the possibility that this response was related to the underlying disorder of POS is considered.