Hirsutism - beyond the steroidogenic block

Article Abstract:

Two articles in the September 27, 1990 issue of The New England Journal of Medicine discuss the evaluation of female patients with hirsutism and other disorders related to the male sex hormones. One traditional response to hirsutism has been to determine if the patient has an androgen-secreting tumor. This may be determined by an assay of the levels of testosterone and dehydroepiandrosterone (DHEA) sulfate in the blood; levels greater than 7 nanomoles per liter and 18.5 micromoles per liter, respectively, are suggestive of a tumor. This approach then relegates all the remaining patients without tumors to the same treatment. Observation of the endocrinological response to an injection of adrenocorticotrophic hormone, or ACTH, gives a clearer picture of the actual defect which may be contributing to hirsutism, menstrual disorders, or otherwise unexplained infertility. Although the test is expensive, it is often justified, since many of the problems which may be identified in this was respond admirably to treatment. Hirsutism due to polycystic ovary may be treated with estrogen and progestin. When the result is found to be late-onset adrenal hyperplasia, the administration of glucocorticoids may result in a reduction in hirsutism and a return to fertility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adrenocortical hormones, Infertility, Menstruation disorders, Hormones, Sex, Sex hormones, ACTH, Corticotropin, editorial, Hypertrichosis

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Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome

Article Abstract:

Polycystic ovary syndrome, also known as Stein-Leninthal syndrome, is characterized by many ovarian cysts on both ovaries (bilateral polycystic ovaries). It causes a markedly diminished menstrual flow (oligomenorrhea) or no menstrual flow (amenorrhea), lack of ovulation (anovulation) resulting in infertility, and abnormal hairiness (hirsutism). The cause of the syndrome is the source of some debate. In order to test one theory, four different groups of subjects were given doses of nafarelin, an agent which stimulates the pituitary gland and the production of gonadotropin-releasing hormones. The groups included normal women, normal men, women with the syndrome, and a woman with polycystic ovary syndrome caused by a well-defined deficiency of 3B-hydroxysteroid dehydrogenase. The responses of each group to nafarelin were analyzed. Gonadotropin stimulation resulted in a normal to increased production of estrogen in the blood, and in higher levels of androstenedione (a steroid hormone causing masculinization) in women with polycystic ovary syndrome. The results indicate that the pituitary and ovarian reactions to nafarelin by women with polycystic ovary syndrome are masculinized, and that these women have abnormal regulation of several ovarian functions.

Analysis, Luteinizing hormone, Stein-Leventhal syndrome, Polycystic ovary syndrome, Cytochrome P-450, Hydroxyprogesterone, Follicle-stimulating hormone

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Detection of functional ovarian hyperandrogenism in women with androgen excess

Article Abstract:

Increased levels of androgens in women with irregular menstruation, excessive facial and body hair or acne may be caused by excess production of androgens by the ovaries in most cases. Androgens are male hormones normally produced in small quantities in women by the ovaries and adrenal glands. Of 40 women between the ages of 17 and 39 with increased blood androgen levels who had irregular menstruation, excessive body and facial hair or acne, 23 (58%) had increased response to nafarelin, 23 (58%) had increased response to corticotropin and 13 (33%) had both. Nafarelin is a drug that stimulates the ovaries; corticotropin stimulates the adrenal gland. Of the 13 with increased response to nafarelin who underwent ultrasound, seven (54%) had polycystic ovaries, and 22 had elevated blood levels of serum luteinizing hormone (LH). Polycystic ovary syndrome has been associated with increased blood levels of androgen hormones and serum LH.

Ovaries, Androgens

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