17-hydroxyprogesterone Concentrations Research Articles

Evaluation of serum concentrations of cortisol and sex hormones of adrenal gland origin after stimulation with two synthetic ACTH preparations in clinically normal dogs

To compare the adrenocortical response of healthy dogs to a commonly used dose of a nonadsorbed tetracosactide product (tetracosactide) with responses to 2 doses of a depot formulation of tetracosactide (depot tetracosactide). 14 dogs. Dogs were randomly assigned to receive tetracosactide (5 mg/kg, IV) or depot tetracosactide (250 μg, IM, or 5 μg/kg, IM). Dogs received each treatment once with a 2-week interval between treatments. Blood samples were assayed for cortisol, progesterone, 17-hydroxyprogesterone, androstenedione, and estradiol concentrations. Serum cortisol concentrations were significantly higher than the preadministration (baseline) concentrations for all treatments 60 minutes after administration of ACTH. Peak cortisol concentration was detected 180 minutes after IM administration of 250 μg of the depot tetracosactide. Serum concentrations of progesterone, 17-hydroxyprogesterone, and androstenedione did not differ significantly from baseline concentrations after stimulation with the 5 μg/kg dose of depot tetracosactide. Adrenal gland progesterone response was significantly higher than baseline concentrations at 60 minutes after administration of the 250-μg dose of depot tetracosactide, and the 17-hydroxyprogesterone and androstenedione responses were significantly higher than baseline concentrations at 120 minutes. Compared with the response to tetracosactide, adrenocortical response was higher and more sustained following administration of the depot tetracosactide, except for androstenedione concentration, which had a nonsignificant response. Except for androstenedione concentrations, a high dose of the depot tetracosactide (250 μg, IM) induced an adrenocortical response similar to that after administration of tetracosactide. Thus, depot tetracosactide may represent an alternative to the nonadsorbed tetracosactide product.

Relationship between 17-hydroxyprogesterone caproate concentrations and gestational age at delivery in twin gestation

Relationship between 17-hydroxyprogesterone caproate concentrations and gestational age at delivery in twin gestation

An X-traordinary stroke

In January, 2010, a 60-year-old non-smoking, white man with mild intellectual disability, presented with acuteonset diplopia and ataxic gait. There was no consanguinity or relevant family history. CT of the brain showed a left cerebellar infarct. Blood tests showed he had polycythaemia with haemoglobin of 220 g/L (normal range 130–170). Investigations to fi nd a cause for the polycythaemia showed that although his erythropoietin concentration was normal and JAK2 mutation screening negative, serum total testosterone concentration was high at 29·1 nmol/L (normal 550 nmol/L at 30 min or 60 min), high serum concentrations of 17-hydroxyprogesterone 66·9 nmol/L (<5 nmol/L) and of androstendione, 31·6 nmol/L (2·0–9·1). His urinary steroid profi le was consistent with 21-hydroxylase defi ciency. A diagnosis of congenital adrenal hyperplasia was made. Our patient’s polycythaemia was treated with regular venesection, and glucocorticoid therapy was initiated to decrease corticotropin concentrations. Adrenal size decreased substantially within weeks of glucocorticoid initiation. The importance of glucocorticoid therapy to prevent future adrenal crises and androgen excess was emphasised. He may need testosterone therapy to maintain virilisation in the future. In September, 2010 at last follow-up he was stable. Congenital adrenal hyperplasia is the most common cause of antenatal virilisation in females. 95% of cases are due to defi ciency of 21-hydroxylase, an enzyme necessary for the synthesis of cortisol. Low serum cortisol concentrations stimulate secretion of corticotropin, which leads to excess production of androgenic steroids. Treatment is with glucocorticoids to prevent adrenal crisis and to normalise corticotropin concentrations, preventing excess androgen production. Excessive use of glucocorticoids should be avoided, because it can lead to growth retardation and iatrogenic Cushing’s syndrome. Our patient’s congenital adrenal hyperplasia was untreated for decades, and the sustained high concentrations of corticotropin caused severe adrenal hyperplasia with increased androgen production. Androgen excess during growth resulted in his short stature because of premature closure of the epiphyses. Androgen excess leads to polycythaemia through stimulation of erythropoiesis. Although polycythaemia is a well-described risk factor for stroke, androgenic polycythaemia in congenital adrenal hyperplasia has been reported only rarely. Androgen excess should be considered as a cause for poly cythaemia. Our patient’s case highlights the harmful eff ects of unfettered androgen excess in untreated congenital adrenal hyper plasia, and is also an important reminder on the importance of a genital examination as a part of a complete physical examination.

Effect of combined lignan phytoestrogen and melatonin treatment on secretion of steroid hormones by adrenal carcinoma cells

To investigate the in vitro effect of the combination of lignan enterolactone (ENL) or lignan enterodiol (END) with melatonin on steroid hormone secretion and cellular aromatase content in human adrenal carcinoma cells. Human adrenocortical carcinoma cells. Melatonin plus ENL or END was added to cell culture medium along with cAMP (100μM); control cells received cAMP alone. Medium and cell lysates were collected after 24 and 48 hours of cultivation. Samples of medium were analyzed for progesterone, 17-hydroxyprogesterone, androstenedione, aldosterone, estradiol, and cortisol concentration by use of radioimmunoassays. Cell lysates were used for western blot analysis of aromatase content. The addition of ENL or END with melatonin to cAMP-stimulated cells (treated cells) resulted in significant decreases in estradiol, androstenedione, and cortisol concentrations at 24 and 48 hours, compared with concentrations in cells stimulated with cAMP alone (cAMP control cells). The addition of these compounds to cAMP-stimulated cells also resulted in higher progesterone and 17-hydroxyprogesterone concentrations than in cAMP control cells; aldosterone concentration was not affected by treatments. Compared with the content in cAMP control cells, aromatase content in treated cells was significantly lower. The combination of lignan and melatonin affected steroid hormone secretion by acting directly on adrenal tumor cells. Results supported the concept that this combination may yield similar effects on steroid hormone secretion by the adrenal glands in dogs with typical and atypical hyperadrenocorticism.

Determinants of Maternal Sex Steroids During the First Half of Pregnancy

To examine the associations of maternal and child characteristics with early pregnancy maternal concentrations of testosterone, androstenedione, progesterone, 17-hydroxyprogesterone, and estradiol (E2). We analyzed these hormones among 1,343 women with singleton pregnancies who donated serum samples to the Finnish Maternity Cohort from 1986 to 2006 during the first half of pregnancy (median 11 weeks). The associations of maternal and child characteristics with hormone concentrations were investigated by correlation and multivariable regression. Women older than age 30 years had lower androgen and E2 but higher progesterone concentrations than women younger than that age. Multiparous women had 14% lower testosterone, 11% lower androstenedione and 17-hydroxyprogesterone, 9% lower progesterone, and 16% lower E2 concentrations compared with nulliparous women (all P<.05). Smoking mothers had 11%, 18%, and 8% higher testosterone, androstenedione, and 17-hydroxyprogesterone levels, respectively, but 10% lower progesterone compared with nonsmoking women (all P<.05). E2 concentrations were 9% higher (P<.05) among women with a female fetus compared with those with a male fetus. Parity, smoking, and, to a lesser extent, maternal age and child sex are associated with sex steroid levels during the first half of a singleton pregnancy. The effects of smoking on the maternal hormonal environment and the possible long-term deleterious consequences on the fetus deserve further evaluation.

Cushing's disease in a patient with steroid 21-hydroxylase deficiency

Cushing's disease rarely appears as a consequence of hereditary disease. However, familial diseases with diminished glucocorticoid feedback are associated with secondary hypercorticotropinism and have been shown to give rise to pituitary adenomas. We here describe the rare case of a 30-year old female patient with congenital adrenal hyperplasia who also showed clinical signs and a typical history of hypercortisolism that was specified as Cushing's disease. After removal of a pituitary microadenoma, serum-cortisol levels fell below normal and the symptoms improved. However, after four years the menstrual cycle was irregular again and ACTH levels were in the upper range of normal. A corticotropin challenge showed a minor cortisol response but a marked increase in 17-hydroxyprogesterone serum concentrations. Genetic analysis revealed a homozygous mutation in exon 7 of the CYP21A2 gene (CTG>TTG, p.V281L). We conclude that a marked ACTH drive was able to override insufficient 21-hydroxylation and even to cause hypercortisolism. Although we describe a rare case, the impairment of the glucocorticoid feedback system in the context of congenital adrenal hyperplasia and other diseases may contribute to the development of secondary hypercorticotropinism as well as corticotropin producing adenomas.

Comparison of two different radioimmunoassays to measure 17-hydroxyprogesterone during treatment monitoring of children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Background Accurate measurement of 17-hydroxyprogesterone (17-OHP) concentrations is essential for the correct diagnosis and treatment management of children with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21 OHD). Methods We analysed 102 serum samples from 15 children with known 21 OHD twice using two different 17-OHP assays. 17-OHP concentrations were measured by an in-house radioimmunoassay (RIA) after recovery-corrected extraction and chromatographic purification and by a commercially available RIA without extraction (Immunotech). Results The correlation coefficient for results of pairs of 17-OHP concentrations was 0.974. The median ratio (17-OHP concentration measured with the commercial assay/17-OHP concentration measured with the in-house assay) was 0.593 with a 95% confidence interval ranging from 0.258 to 1.370. The ratio was constant throughout the average 17-OHP concentrations ranging from 0.24 to 149.2 nmol/L, as well as throughout the age range from 0.3 to 16.4 years. Conclusions Despite good overall correlation, absolute 17-OHP concentrations differed dramatically. This could lead to misclassification of patients suspected for 21 OHD on the basis of the hormonal profile and to a reduced quality during treatment monitoring of patients with 21 OHD with the risk of under- and overtreatment.

Cortisol measurement in patients receiving metyrapone therapy

Current guidance recommends titrating the dose of metyrapone against serum cortisol concentration, in patients under medical management of Cushing's syndrome. In the UK, this almost always involves measuring serum cortisol concentration by immunoassay, the performance of which is questionable in the presence of altered steroid metabolism. Sera from two patients receiving metyrapone were analysed using a liquid chromatography tandem mass spectrometry (MS) steroid assay to identify which steroids, if any, were elevated in these patients. In addition, control serum was spiked with a series of steroids to identify any potential positive interferences in a cortisol immunoassay. Serum 11-deoxycortisol concentration was elevated in both of the patients studied. One patient also had an elevated serum 17-hydroxyprogesterone concentration and the other an elevated androstenedione. In addition, the results of the interference studies indicated that the cortisol immunoassay was susceptible to interference from 11-deoxycortisol, 17-hydroxyprogesterone and 21-deoxycortisol. However, the magnitude of interference, in the serum cortisol immunoassay, due to these three steroids could not account for the discrepancy between the cortisol concentrations measured by immunoassay and those measured by MS. Both clinicians and laboratory staff should be aware of these interferences when monitoring patients undergoing treatment with metyrapone, and consequently serum should be measured in these patients by MS, not by immunoassay.

Hyperphosphatasemia and concurrent adrenal gland dysfunction in apparently healthy Scottish Terriers

To determine causes of hyperphosphatasemia (high serum alkaline phosphatase [ALP] activity) in apparently healthy Scottish Terriers. Prospective case-controlled study. 34 apparently healthy adult Scottish Terriers (17 with and 17 without hyperphosphatasemia). Serum activities for 3 isoforms (bone, liver, and corticosteroid) of ALP were measured. Concentrations of cortisol, progesterone, 17-hydroxyprogesterone, androstenedione, estradiol, and aldosterone were measured before and after cosyntropin administration (ie, ACTH; 5 microg/kg [2.27 microg/lb], IM). Liver biopsy specimens from 16 dogs (11 with and 5 without hyperphosphatasemia) were evaluated histologically. In dogs with hyperphosphatasemia, the corticosteroid ALP isoform comprised a significantly higher percentage of total ALP activity, compared with the percentage in dogs without hyperphosphatasemia (mean +/- SE, 69 +/- 5.0% and 17 +/- 3.8%, respectively). In 6 dogs with hyperphosphatasemia, but none without, serum cortisol concentrations exceeded reference intervals after ACTH stimulation. Six dogs with and 15 without hyperphosphatasemia had increased concentrations of >or = 1 noncortisol steroid hormone after ACTH stimulation. Serum ALP activity was correlated with cortisol and androstenedione concentrations (r = 0.337 and 0.496, respectively) measured after ACTH stimulation. All dogs with and most without hyperphosphatasemia had abnormal hepatocellular reticulation typical of vacuolar hepatopathy. Subjectively, hepatocellular reticulation was more severe and widespread in hyperphosphatasemic dogs, compared with that in nonhyperphosphatasemic dogs. Hyperphosphatasemia in apparently healthy Scottish Terriers was most likely attributable to hyperadrenocorticism on the basis of exaggerated serum biochemical responses to ACTH administration and histologic hepatic changes, but none of the dogs had clinical signs of hyperadrenocorticism.

Is the DHEAS/cortisol ratio a potential filter for non-operable constipated cases?

Constipation is a significant manifestation of a number of psychological disorders. Published papers recommend using self-assessment questionnaires for discriminating psychological from non-psychological constipated patients before operating on them but reports from major surveys revealed that general practitioners failed to diagnose 70% of depressed patients using self-assessment questionnaires. Lower circulating concentrations of progesterone, 17-hydroxyprogesterone, cortisol, testosterone, androstenedione, and dehydroepiandrostenedione sulfate (DHEAS) during the follicular phase in constipated young women compared with respective controls were found during the follicular phase of the menstrual cycles. During the luteal phase of the cycle, reductions were identified in estriol, cortisol and testosterone in the constipated group. Likewise, circulating concentrations of DHEAS were found to be lower in depressed patients than comparable healthy controls. DHEAS/cortisol ratios in morning serum and salivary samples were lower than those retrieved during other times of the day in depressed patients. The idea of recognizing major depression in constipated patients by measuring DHEAS/cortisol ratios in saliva and serum may be plausible but this possibility needs to be confirmed in well-designed studies.

Crescimento de pacientes com hiperplasia congênita das supra-renais, forma perdedora de sal, nos dois primeiros anos de vida

OBJETIVOS: avaliar crescimento e recuperação nutricional de pacientes com hiperplasia congênita supra-renal, forma clássica perdedora de sal, nos dois primeiros anos de vida. MÉTODOS: analisamos escores z de peso e comprimento de 21 pacientes ao nascimento, primeira consulta, com um e dois anos de idade. Determinamos concentrações de 17-hidroxiprogesterona, androstenediona e doses de hidrocortisona prescritas da primeira consulta até um e dois anos de idade (períodos 1 e 2, respectivamente). RESULTADOS: a média de idade na primeira consulta foi 36,7 dias. Escore z do peso ao nascimento foi -0,23±1,4; na primeira consulta -2,31±1,3; com um ano -1,43±1,6 e dois anos -0,77± 1,3. Escore z do comprimento ao nascimento foi -0,69±2,3; na primeira consulta -1,87±1,7; com um ano -1,68±1,1 e dois anos -1,07±1,0. A diferença entre os escores aos dois anos e na primeira consulta foi 1,54±1,7 para o peso e 0,80±1,6 para o comprimento. Média de hidrocortisona prescrita foi 21,3 e 19,9 mg/m2/dia nos períodos 1 e 2 e concentrações (ng/dL) de 17-hidroxiprogesterona e androstenediona foram 9,1 e 0,14 no período 1 e 4,4 e 0,27 no 2, respectivamente. CONCLUSÕES: foram observados recuperação nutricional com o tratamento e, aos dois anos, peso e comprimento normais, embora inferiores aos da população.

Studies on the diurnal variations of 17-hydroxyprogesterone in saliva by enzyme immunoassay in patients with congenital adrenal hyperplasia.

The diurnal rhythm of 17-hydroxyprogesterone concentration in the saliva was determined in 11 patients with congenital adrenal hyperplasia ranging in age from 9 to 20 years. A total of 21 tests were performed using a 17-OHP-enzyme immunoassay. The investigations were carried out during normal school or working days. The tests were done 16 times in patients with optimal therapeutic control and 5 times in patients with undertreatment. The concentrations of saliva 17-OHP in the morning were significantly lower after a therapy interval during the night of 8 hours than of more than 10 hours. In patients with poor substitution all values of the days were higher than in patients with optimal therapy control. The morning values are appropriate for the evaluation of the therapy control. With regular 8 hours' therapy intervals the limit between normal and pathological values may be about 500 pmol/l saliva.

Human Early Pregnancy Factor and Early Pregnancy Associated Protein before and after Therapeutic Abortion in Comparison with ß-hCG, Estradiol, Progesterone and 17-Hydroxyprogesterone*)

Serum activities and concentrations, respectively, of early pregnancy factor (EPF), early pregnancy associated protein (EPAP), beta-hCG, estradiol, progesterone and 17-hydroxyprogesterone were estimated in 20 healthy primigravidae within the tenth to twelfth completed gestational week before and after therapeutic abortion. EPF, beta-hCG and estradiol markedly decreased after termination of pregnancy, whereas progesterone and 17-hydroxyprogesterone concentrations moderately fell. EPAP showed no significant alterations in a 24 hours period. Because of its possible role as immunosuppressive substance and its short half-life EPF may be a promising immunobiomarker for disturbances in early pregnancy.

Adrenal Function during Childhood and Puberty in Daughters of Women with Polycystic Ovary Syndrome

In some patients, PCOS may develop as a consequence of an exaggerated adrenarche during pubertal development. The aim of the study was to assess adrenal function during childhood and pubertal development in daughters of women with PCOS (PCOSd). We included 98 PCOSd [64 during childhood (ages 4-8 yr) and 34 during the peripubertal period (ages 9-13 yr)] and 51 daughters of control women (Cd) [30 during childhood and 21 during the peripubertal period]. In both groups, an acute ACTH-(1-24) stimulation test (0.25 mg) and an oral glucose tolerance test were performed. Bone age and serum concentrations of cortisol, androstenedione, 17-hydroxyprogesterone, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), glucose, and insulin were determined. PCOSd and Cd were similar in age and body mass index. During the peripubertal period, basal and poststimulated DHEAS concentrations were higher in PCOSd compared to Cd. Among PCOSd, 12.5% of girls in childhood and 32.4% in peripuberty presented biochemical evidence of exaggerated adrenarche. Stimulated insulin was higher in PCOSd compared to Cd during childhood (P = 0.03) and peripuberty (P = 0.03). An advancement of 8 months between bone and chronological age was observed in peripubertal PCOSd compared to Cd. In PCOSd, basal and stimulated DHEAS concentrations were higher during the onset of puberty. Around 30% of the PCOSd demonstrated an exacerbated adrenarche, which may reflect increased P450c17 activity. In addition, a modest advance in bone age was observed, probably secondary to the hyperinsulinemia and/or adrenal hyperandrogenism.

Management of Altered Hydrocortisone Pharmacokinetics in a Boy with Congenital Adrenal Hyperplasia Using a Continuous Subcutaneous Hydrocortisone Infusion

Conventional hydrocortisone dosing schedules do not mimic the normal circadian rhythm of cortisol, making it difficult to optimize treatment in congenital adrenal hyperplasia (CAH). We report a 14.5-year-old boy with CAH who had reduced bioavailability [42% (normal 80% orally and 100% by im route)] and increased clearance [half-life 50 min (normal range, 70-100 min)] of oral doses of hydrocortisone leading to ambient serum 17-hydroxyprogesterone concentrations of 400 nmol/liter (14.5 ng/ml) and androstenedione concentrations of 24.9 nmol/liter (7.1 ng/ml). Using a continuous but variable sc hydrocortisone infusion via an insulin pump, rapid control of his CAH was attained with a normal cortisol circadian profile. Average daily hydrocortisone dose was 17.4-18.6 mg/m(2), which produces on average 24-h serum cortisol and 17-hydroxyprogesterone concentrations of 316 nmol/liter (115 ng/ml) and 4.3 nmol/liter (1.4 ng/ml), respectively. Therapy has been maintained over 4 yr with suppression of normal adrenal androgen production and normal progression through puberty. Continuous sc infusion of hydrocortisone may prove a valuable adjunct to therapy for CAH, particularly in patients requiring high doses of oral hydrocortisone and in those with abnormal hydrocortisone pharmacokinetics.

Assessment of cytologic evaluation of preputial epithelial cells as a diagnostic test for detection of adrenocortical disease in castrated ferrets

To determine whether results of cytologic evaluation of preputial epithelial cells correspond to results of a serum endocrine hormone assay and clinical signs associated with adrenocortical disease in castrated ferrets. 13 clinically normal ferrets and 8 ferrets with signs of adrenocortical disease. Blood and preputial lavage samples were collected from each ferret. Serum samples were submitted to the University of Tennessee Veterinary Diagnostic Laboratory for performance of an endocrine hormone assay. Differential epithelial cell counts were performed on preputial lavage samples to determine the percentage of cornified cells. Results of cytologic evaluation were compared with results of the endocrine hormone assay and clinical status of ferrets. The percentage of cornified preputial epithelial cells was not significantly correlated with serum 17B-estradiol or androstenedione concentration but was significantly correlated with serum 17-hydroxyprogesterone concentration (r = 0.60). The percentage of cornified preputial epithelial cells was higher in ferrets with clinical signs of adrenocortical disease (mean +/- SD, 71.3 +/- 16.9%) than in clinically normal ferrets (55.5 +/- 19.0%). Cornification of preputial epithelial cells was correlated with an increase in serum 17-hydroxyprogesterone concentration as well as clinical signs of adrenocortical disease in castrated ferrets. Additional investigation is needed to elucidate the mechanism of preputial epithelial cell cornification in castrated ferrets.

Inhibin and steroid response to testicular stimulation with pure FSH (Metrodin) in infertile men with unilateral cryptorchidism.

Static measurements of immunoreactive inhibin have proven of little relevance in the diagnosis of testicular disorders. Dynamic evaluation of the inhibin secretory reserve might detect a specific Sertoli cell defect in a subgroup of infertile men. We compared the response of inhibin and steroids to an intravenous injection of pure FSH (Metrodin, Serono, 300 IU) in 13 infertile men with unilateral cryptorchidism to that in eight normal fertile men. Blood was aspirated before, 24, 48, and 72 h after the FSH injection. Two subgroups of patients with unilateral cryptorchidism were detected: those who responded by secreting inhibin in a pattern similar to normal men (seven patients), and those who responded poorly or not at all (six patients). The presumed cause of this difference is a defect of Sertoli cell reserve function due to a combination of insults to the testes, and not to cryptorchidism itself. The difference in response to FSH cannot be predicted from semen analysis nor from static hormone measurements. Overall, inhibin levels correlated significantly with the serum concentrations of FSH (r = -0.36, P < 0.05), testosterone (r = 0.37, P < 0.05), and 17-hydroxyprogesterone (r = 0.66, P < 0.001). It is concluded that, in infertile men with unilateral cryptorchidism, Stimulation of Sertoli cells by FSH can identify a subgroup of patients with Sertoli cell malfunction involving inhibin synthesis.

Testicular steroid response to continuous and pulsatile intravenous luteinizing hormone-releasing hormone administration in normal men.

In 18 healthy normal men Leydig cell response was examined following intravenous luteinizing hormone-releasing hormone (LH-RH) administration under standardized conditions. The same total amount of LH-RH was administered for 3 hours both in a continuous (1 microgram/min; C (1,1)) and in a pulsatile fashion, by giving a 20 micrograms dose at 20 minutes intervals, P (20, 20), and a 60 micrograms dose at 60 minutes intervals, P (60, 60). Following the different modes of LH-RH administration which all caused 3-4 fold elevations of the mean endogenous luteinizing hormone (LH) concentrations and 1.7-2 fold elevations of the mean follicle-stimulating hormone (FSH) serum levels, an overt increase of the mean testosterone (T) levels was noticed up to 1.5 X the baseline value. No difference was observed in the total amount of T release among the investigated groups. The patterns of the T response, however, clearly differed from one another with a rapid increase, during the C (1, 1) and the P (20, 20) LH-RH administration, and a delayed but persistent T increase in the P (60, 60) experiment. The mean 17-hydroxyprogesterone (17-OHP) concentrations demonstrated a similar course to T in the P (60,60) experiment, while significant increases of the oestradiol (E 2) levels were never observed in all three experiments. In view of the comparable LH and FSH increments in response to LH-RH administration in either experiment the differences in T responses may be explained by assuming a direct effect of LH-RH on Leydig cell steroidogenesis in the men.

Adrenal Androgen Production Capacity Remains High up to Menopause in Women with Polycystic Ovary Syndrome

Hyperandrogenism is one of the main features of polycystic ovary syndrome (PCOS). Of circulating androgens, 50% of androstenedione and testosterone are of ovarian and adrenal origin, whereas dehydroepiandrosterone (DHEA) and DHEA sulfate are almost uniquely of adrenal origin. Our previous studies have indicated that ovarian androgen production capacity is enhanced in women with PCOS, and it remains high until late reproductive age. To study whether this also applies to adrenal androgen production, ACTH tests were performed in healthy women and in women with PCOS. Sixty-nine healthy women (aged 19-62 yr; body mass index 19.2-35.0 kg/m2) and 58 women with previously diagnosed PCOS (aged 18-59 yr; body mass index 19.0-42.9 kg/m2) participated in the study. The subjects underwent ACTH stimulation tests, and serum cortisol, 17-hydroxyprogesterone, androstenedione, testosterone, DHEA, and DHEA sulfate levels were analyzed at 0, 30, and 60 min. Basal and ACTH-stimulated levels of most adrenal androgens decreased in healthy women with age, whereas in women with PCOS, only the concentrations of basal serum 17-hydroxyprogesterone decreased, and all areas under the curve (AUCs) remained unchanged and significantly higher (except for DHEA) than those in control women. Likewise, at the menopausal transition, pre- and postmenopausal women with PCOS exhibited mainly unchanged and higher basal androgen and AUC levels. Similarly to ovarian endocrine function, serum adrenal steroid levels and adrenal steroid production capacity remain enhanced at least up to menopause in women with PCOS.

Adrenal Androgen Production Capacity Remains High up to Menopause in Women with Polycystic Ovary Syndrome

Hyperandrogenism is one of the main features of polycystic ovary syndrome (PCOS). Of circulating androgens, 50% of androstenedione and testosterone are of ovarian and adrenal origin, whereas dehydroepiandrosterone (DHEA) and DHEA sulfate are almost uniquely of adrenal origin. Our previous studies have indicated that ovarian androgen production capacity is enhanced in women with PCOS, and it remains high until late reproductive age. To study whether this also applies to adrenal androgen production, ACTH tests were performed in healthy women and in women with PCOS. Sixty-nine healthy women (aged 19–62 yr; body mass index 19.2–35.0 kg/m2) and 58 women with previously diagnosed PCOS (aged 18–59 yr; body mass index 19.0–42.9 kg/m2) participated in the study. The subjects underwent ACTH stimulation tests, and serum cortisol, 17-hydroxyprogesterone, androstenedione, testosterone, DHEA, and DHEA sulfate levels were analyzed at 0, 30, and 60 min. Basal and ACTH-stimulated levels of most adrenal androgens decreased in healthy women with age, whereas in women with PCOS, only the concentrations of basal serum 17-hydroxyprogesterone decreased, and all areas under the curve (AUCs) remained unchanged and significantly higher (except for DHEA) than those in control women. Likewise, at the menopausal transition, pre- and postmenopausal women with PCOS exhibited mainly unchanged and higher basal androgen and AUC levels. Similarly to ovarian endocrine function, serum adrenal steroid levels and adrenal steroid production capacity remain enhanced at least up to menopause in women with PCOS.