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PubMed2006

Endocrinological markers for assessment of hyperandrogenemia in hirsute women.

BACKGROUND: Measured endocrinological parameters (total testosterone [TT], free testosterone [FT], dihydrotestosterone [DHT], dehydroepiandrosterone sulfate [DHEAS], and sex hormone binding globulin [SHBG]) and calculated parameters (calculated FT (cFT), calculated bioavailable testosterone (cBT), and the free androgen index [FAI]) in women with hirsutism were compared to the values of a control group. The question remains if cFT or cBT are more appropriate markers for assessment of hyperandrogenemia in clinical situations such as hirsutism in women. METHODS: Sixty-six women showed an modified Ferriman-Gallwey (mF-G) score of >or=6 and were classified as hirsutism group and 58 women showed mF-G scores of <or=5 and were classified as control group. TT, FT, DHT, DHEAS, and SHBG were measured with enzyme immunoassays in one serum sample. Albumin was measured in the same sample. Afterwards, cFT, cBT, and the FAI were calculated. RESULTS: The hirsutism group revealed significantly increased cFT, cBT, and FAI, while SHBG was significantly decreased compared to the controls. All values of the hirsutism group showed significant, but poor correlation with the mF-G score. SHBG correlated negatively with the mF-G score and BMI. CONCLUSION: Despite the limited correlation of all endocrinological parameters to severity of hirsutism described by the mF-G score, cFT, cBT, and FAI may be more appropriate markers for assessment of hyperandrogenemia in women with hirsutism in comparison with measured values of simple enzyme immunoassays.

Adult↗
PubMed1975

Adrenal function in hirsutism I. Diurnal change and response of plasma androstenedione, testosterone, 17-hydroxyprogesterone, cortisol, LH and FSH to dexamethasone and 1/2 unit of ACTH.

ACTH dependency of plasma androstenedione (A) and testosterone (T) was determined in normal and hirsute women by measuring the magnitude of change of A and T between the time of the cortisol (F) peak and F nadir in a diurnal study. There was a significant diurnal rhythm of A synchronous with F in both normal and hirsute women (P less than 0.01). Five of 12 hirsute women had a greater than normal diurnal swing of A (P less than 0.05), but only 2 of the 12 had a greater than normal diurnal swing of T. Responsiveness of A and T to 1/2 unit of intravenous ACTH was determined after dexamethasone 1 mg was given the night before. Plasma A and T were elevated in most of the hirsute women during acute ACTH suppression by dexamethasone, indicating ACTH-independent hypersecretion of androgens. Nine of 17 hirsute women had a greater than normal A response to ACTH (P less than 0.05). Those who had an exaggerated diurnal swing of A also had hyper-responsiveness of A secretion to ACTH. Only 2 hirsute women had an exaggerated T response to ACTH. Some T levels were decreased by ACTH. Seven of the 9 hiruste women who had an exaggerated A response to ACTH had a normal maximum F response, but a greater than normal 17-hydroxy-progesterone (17-OHP) response to ACTH with a high 17-OHP to F ratio, suggesting they have a mild but compensated reduction in 21-hydroxylase or 11beta-hydroxylase activity. Two women with hyper-responsiveness of A secretion had low F and 17-OHP responses to ACTH suggesting reduced C21 but intact C19 3beta-hydroxysteroid dehydrogenase-delta-5,-4 isomerase activity. These apparent reduced enzyme activity may not be congenital, but induced by an altered hormonal milieu such as an abnormal androgen-estrogen ratio. It is concluded that ACTH uniformly stimulated A secretion but not T secretion and that approximately 50% of the hirsute women had ACTH-dependent hypersecretion of A, but most of these also had concurrent ACTH-independent hypersecretion of androgens.

Adrenal Glands↗
PubMed1976

Obesity and oligomenorrhea are associated with hyperandrogenism independent of hirsutism.

Obesity, oligomenorrhea, and hirsutism are frequently associated with high plasma androgen levels and/or low testosterone-binding globulin (TEBG) levels. Studied have been undertaken to determine the extent to which each of these clinical features may be related to this hormonal profile. Indexes of plasma free (unbound) androgen levels were focused upon because this fraction appears to be the biologically active portion of the plasma androgens. The hormonal profile was normal in women with either obesity or oligomenorrhea alone and abnormal in those with severe hirsutism alone. On striking new finding was that subjects with the combination of obesity and oligomenorrhea had elevated plasma total and free androgens and depressed TEBG even in the absence of hirsutism. Furthermore, the androgen levels were higher in obese oligomenorrheic women with mild hirsutism than in severely hirsute women who were not obese. Plasma estradiol concentrations were normal in these obese women. A simple explanation for elevated free plasma androgen levels in obese women who were oligomenorrheic yet had little if any hirsutism is not possible. The data are compatible with the concept that obesity is a variably expressed manifestation of slightly elevated plasma free androgen levels or that obesity is an incidental finding which somehow blunts the effect of high androgen levels on hair follicles. Regardless of the explanation, oligomenorrheic obese women must be suspected of having high androgen production even in the absence of hirsutism.

Adult↗
PubMed1984

The incidence of late-onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency among hirsute women.

Late-onset congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is a cause of hirsutism in adult women. Its reported frequency of occurrence in hirsute women has varied from 0-30%, but the number of patients studied was small. To establish the incidence of CAH, 83 unselected hirsute women were studied prospectively with a standard ACTH stimulation test. On the basis of an exaggerated response of serum 17 alpha-hydroxyprogesterone to ACTH, 1 patient with CAH was found, for an incidence of 1.2%. The 95% confidence limits for the incidence of CAH among hirsute women were 0% and 3.4%. Five of seven hirsute women without CAH whose serum 17 alpha-hydroxyprogesterone levels rose above 3 ng/ml in response to ACTH had simultaneous serum progesterone values consistent with recent ovulation. Since routine screening of all hirsute women by means of ACTH stimulation does not appear to be cost effective, reported cases of CAH were reviewed in order to discern potentially helpful clinical clues. Severe hirsutism, virilization, early onset of symptoms, short stature, familial occurrence, and regular menses were identified as the clinical characteristics associated with late-onset CAH.

17-alpha-Hydroxyprogesterone↗
PubMed1993

Androsterone sulfate: physiology and clinical significance in hirsute women.

Androsterone sulfate (Andros-S) is the most abundant 5 alpha-reduced androgen metabolite in serum. To determine whether this steroid could serve as a marker of 5 alpha-reductase activity, we developed a specific RIA, using tritiated Andros-S to assess procedural losses. Baseline serum Andros-S levels (mumol/L; mean +/- SEM) in 14 hirsute women (3.0 +/- 0.4) were not reduced by ovarian suppression with leuprolide (3.0 +/- 0.3), but were decreased by 79% with combined ovarian and adrenal suppression with leuprolide and dexamethasone. The mean Andros-S level in polycystic ovarian syndrome (3.2 +/- 0.4) and in idiopathic hirsutism (3.5 +/- 0.5) was not significantly different from levels in normal women (3.0 +/- 0.5), but were significantly greater than levels in obese women (1.7 +/- 0.3; P < 0.05). The serum concentrations of Andros-S were about 10-fold greater than those of androsterone glucuronide and 100-fold greater than those of androstanediol glucuronide. Serum Andros-S concentrations correlated strongly with dehydroepiandrosterone sulfate (R = 0.59; P < 0.001) and to a lesser degree with androstanediol glucuronide and androsterone glucuronide (R = 0.28 and 0.49, respectively). There was a weak correlation with androstenedione levels and the androstenedione response to ACTH (R = 0.38 and 0.34, respectively), and no significant correlation with serum testosterone (R = 0.19). The ratio of any of the 5 alpha-reduced products (Andros-S, androstanediol glucuronide, and androsterone glucuronide) to precursors (androstenedione and testosterone) was not increased in hirsute women, suggesting that these women did not have a generalized increase in 5 alpha-reductase activity. In conclusion, these results confirm that Andros-S is the most abundant 5 alpha-reduced androgen metabolite in serum. It is primarily, if not exclusively, of adrenal origin in hirsute women. The fact that its levels were not elevated in hirsutism, although those of other adrenal androgens and androgen metabolites (androstanediol glucuronide and androsterone glucuronide) were, suggests that variations in sulfotransferase activity or metabolic clearance of Andros-S may be important determinants of serum Andros-S levels. Although Andros-S may be a marker of systemic 5 alpha-reductase activity, there was no evidence of a generalized increase in 5 alpha-reductase activity in hirsute women. Andros-S is therefore not recommended as a marker of either adrenal androgen production or of hirsutism.

17-alpha-Hydroxyprogesterone↗
PubMed1993

Ovarian steroidogenic responses to gonadotropin-releasing hormone agonist testing with nafarelin in hirsute women with adrenal responses to adrenocorticotropin suggestive of 3 beta-hydroxy-delta 5-steroid dehydrogenase deficiency.

Nonclassical 3 beta-hydroxy-delta 5-steroid dehydrogenase (3 beta-HSD) deficiency type of congenital adrenal hyperplasia has been hypothesized to occur in as many as 10-40% of hirsute women, based on the adrenal steroidogenic responses to ACTH. However, diagnostic criteria for this "late-onset" 3 beta-HSD deficiency are not clearly established. Among 40 successive hyperandrogenic women undergoing evaluation of adrenal steroidogenic responses to ACTH, 8 had responses suggestive of 3 beta-HSD deficiency. Since 3 beta-HSD is present in both the ovary and adrenal, we attempted to document the defect in the ovary by stimulating their ovarian function with a gonadotropin-releasing hormone agonist test using nafarelin (6-D-[2-naphthyl]alanine-gonadotropin-releasing hormone). The eight hirsute women had steroid responses to ACTH suggestive of 3 beta-HSD deficiency, namely, the values of the delta 5-steroids, 17-hydroxypregnenolone and dehydroepiandrosterone, 30 and 60 min after ACTH in each hirsute woman were greater than 2 SD above the normal mean. Seven of the eight hirsute women had at least one elevated delta 5/delta 4-steroid ratio; however, only three of the hirsute women had two abnormal ratios. Furthermore, the response of the delta 4-steroid androstenedione and the ratio of androstenedione to cortisol after ACTH were significantly increased in the hirsute women, findings not consistent with 3 beta-HSD deficiency. After nafarelin, five and six hirsute patients had elevated values of the delta 4-steroids androstenedione and 17-hydroxyprogesterone, respectively. No patient had an elevated delta 5/delta 4-steroid ratio after nafarelin. Thus, ovarian steroidogenic responses to nafarelin did not support the diagnosis of 3 beta-HSD deficiency. Rather, they are consistent in most cases with polycystic ovary syndrome due to dysregulation of 17-hydroxylase and 17,20-lyase activities. We propose that increased activity of the enzyme P450c17 alpha in the adrenal cortex is responsible for most of what is often termed late-onset 3 beta-HSD deficiency.

17-alpha-Hydroxypregnenolone↗
PubMed2002

Comparison of high-dose finasteride (5 mg/day) versus low-dose finasteride (2.5 mg/day) in the treatment of hirsutism.

OBJECTIVE: To compare the clinical efficacy and safety of high-dose (5 mg/day) and low-dose (2.5 mg/day) finasteride in the treatment of hirsutism in women. DESIGN: A prospective, randomized and controlled clinical trial. METHODS: Fifty-six hirsute women with moderate to severe hirsutism were prospectively evaluated to see the effects of low-dose (2.5 mg/day) and high-dose (5 mg/day) finasteride. Patients were randomly divided into two treatment groups. Group I (n=29) received 2.5 mg finasteride/day and group II (n=27) received 5 mg finasteride/day orally for 1 year. Hirsutism score, body mass index and hormonal parameters (FSH, LH, estradiol, androstenedione, testosterone, free testosterone, 17alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate and sex hormone-binding globulin) were measured in all the patients before treatment and repeated at six-monthly intervals. RESULTS: The hirsutism scores decreased significantly at months 6 and 12 from a mean+/-s.d. of 18.4+/-4.6 to 13.3+/-5.2 (P<0.001) and 18.4+/-4.6 to 8.6+/-4.2 (P<0.001) in group I and from 18.7+/-5.2 to 13.9+/-5.3 (P<0.001) and 18.7+/-5.2 to 10.3+/-5.0 (P<0.001) in group II respectively. No significant changes in the blood chemistry and hormonal parameters except estradiol levels were observed. No serious side-effects were seen in the two groups. In group II, estradiol levels increased significantly at 6 and 12 months. CONCLUSIONS: In this study, hirsutism scores decreased significantly at 6 and 12 months in both groups I and II. Low-dose (2.5 mg/day) finasteride is safe and cost effective in the treatment of hirsutism and may be used instead of high-dose finasteride (5 mg/day) therapy.

17-alpha-Hydroxyprogesterone↗
PubMed2000

Bone mineral density in women with idiopathic hirsutism.

Idiopathic hirsutism is relatively uncommon, affecting approximately 6% of hirsute women. In the present study we compared the bone mineral density (BMD) of women with idiopathic hirsutism with controls. A group of 20 women diagnosed with idiopathic hirsutism was evaluated with respect to BMD and the findings were compared to those of a control group consisting of 10 normal women. Hirsutism was graded according to the Ferriman-Gallwey score and threshold was considered to be a score more than 4. There was no statistically significant difference with respect to patients' mean age, BMI and body fat composition. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), androstenedione, testosterone, free testosterone, 17 alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG) and estradiol were assessed in both groups and no statistically significant differences were found. There was no statistically significant difference with respect to bone turnover--which was evaluated by determining the serum levels of parathyroid hormone, calcium, alkaline phosphatase and osteocalcin as well as the urinary secretion of calcium and hydroxyproline, corrected for the creatinine values--between the two groups. Statistical analysis was performed using the t test for unpaired data to compare age, BMD and biochemical data, and Wilcoxon's rank test was used to compare physical activity and calcium intake. Statistical significance was defined as p < 0.05. The BMD at the level of the 2nd to 4th lumbar vertebrae (L2-L4) and the total BMD were higher in women with idiopathic hirsutism compared to those in the control group, suggesting a possible direct effect of androgens on the osseous tissue of hirsute women.

17-alpha-Hydroxyprogesterone↗
PubMed1996

Comparison of four different treatment regimes in hirsutism related to polycystic ovary syndrome.

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 +/- 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated.

Adolescent↗
PubMed2000

[Treatment of hirsutism with spironolactone and with spironolactone plus dexamethasone].

BACKGROUND: Spironolactone has an anti androgenic effect, inhibiting the binding of androgens to their receptor. This antagonistic effect is the basis for the use of spironolactone in the treatment of hirsutism. AIM: To study the effectiveness and safety of spironolactone in the treatment of hirsute women and of the association of spironolactone plus dexamethasone in the treatment of hirsutism with glucocorticoid sensitive hyperandrogenism. PATIENTS AND METHOD: Sixteen women (group 1) with peripheral hirsutism (defined as those with normal androgens levels, normal menstrual cycles and ovulation) and 24 women (group 2) with glucocorticoid sensitive hyperandrogenic hirsutism were studied. Group 1 was treated with spironolactone 50 mg hid and group 2 with same spironolactone dose plus dexamethasone 0.5 mg at 23 h during one month and 0.25 mg thereafter. Patients were followed during one year. RESULTS: After one year of treatment, a 54% reduction in Moncada hirsutism escore was observed in group 1 and 52% reduction in group 2. Observed secondary effects of spironolactone were increases in diuresis, fatigability, acne aggravation and seborrhea in two patients. Two additional patients had spotting. No secondary effect attributable to glucocorticoid use were observed. CONCLUSIONS: Spironolactone is effective and safe in the treatment of hirsutism. Androgenic supression did no increases its effectiveness, underscoring the peripheral anti androgenic activity os spironolactone.

Adolescent↗
PubMed2002

New alternative treatment in hirsutism: bicalutamide 25 mg/day.

The efficacy of low-dose bicalutamide (25 mg/day) in the treatment of hirsutism was investigated in this study. Hirsutism score was determined, according to a modified Ferriman-Gallwey scoring system, in 42 women with hirsutism. Each patient received 25 mg/day bicalutamide. Before therapy, multiscreen blood chemistry, hormonal analysis, and complete blood counts were performed. These parameters and hirsutism scores were repeated at 3 and 6 months during therapy. The paired Student's t-test was used to compare repeated values. Clinical improvement in the degree of hirsutism was observed in all patients by the same author. The modified Ferriman-Gallwey scores decreased from a mean of 22.0 +/- 5.1 to 8.6 +/- 3.5 (p < 0.0001). The reduction in hirsutism scores was 41.2 +/- 11.4% at 3 months and 61.6 +/- 11.1% at 6 months. In conclusion, bicalutamide at 25 mg/day is an effective drug in the treatment of patients with hirsutism.

17-alpha-Hydroxyprogesterone↗
PubMed1975

Ovarian and adrenal contributions to peripheral androgens in hirsute women.

Serum levels of testosterone (T), 5alpha-dihydrotestosterone (DHT), androstenedione (A), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), 17-hydroxyprogesterone (17-P), and cortisol (F) were measured in 33 hirsute women. Ten were hirsute and eumenorrheic (H-E), and 23 were hirsute and oligomenorrheic or amenorrheic (H-OA). Daily morning blood samples were obtained for 6 consecutive days. Dexamethasone (Dex), 2 mg/day was administered starting after venipuncture on the second day and continuing for 5 days. Human chorionic gonadotropin (hCG) was administered intramuscularly on the afternoon of the fourth and fifth days. The mean levels of all steroids measured under basal conditions in the hirsute women as a group were significantly elevated when compared to nonhirsute premenopausal women. Dehydroepiandrosterone-sulfate was the only steroid which showed significantly different mean levels between the two groups of hirsute women, being higher in the H-OA patients. Individual hirsute patients showed an elevated serum 17-P level as the most consistent finding; it was present in 90% of the patients in both groups. Significantly more H-E patients showed Dex-suppressible DHT (90% vs 40%; P less than 0.05) and A (70% vs 25%; P less than 0.05) than did H-OA patients. Dex-suppressibility of 17-P was observed in only 20% of the H-E and 15% of H-OA patients. A positive response to hCG was observed in all patients for serum 17-P and in about half or less of the patients for the other steroids. These dynamic tests of adrenal suppression and ovarian stimulation suggest that the ovary may be the main source of 17-P overproduction in both groups of patients. Although 17-P has been previously postulated to have androgenic activity, it is not yet known whether this steroid has a causal relationship to hirsutism.

Adrenal Glands↗
PubMed2004

Hirsutism: common clinical problem or index of serious disease?

Hirsutism is a clinical condition commonly encountered in the practice of primary care medicine. The etiology and the age of the patient when it occurs vary widely. Causes range from a basic illness or condition (drug exposure, smoking, idiopathic, and obesity) to complex and serious diseases (Cushing's syndrome, neoplasms, congenital adrenal hyperplasia, insulin-resistance syndromes, hyperprolactinemia, polycystic ovary syndrome, and hyperthecosis). Hirsutism may appear in childhood as well as in older persons. Some drugs (oral contraceptives, L-thyroxine, danazol, and diazoxide), tobacco smoke, some syndromes (polycystic ovary syndrome, obesity, insulin resistance, hyperprolactinemia, hyperthecosis, congenital adrenal hyperplasia, and idiopathic), and some neoplasms (adrenal or ovarian) may lead to hirsutism. The most frequently defined "causes" of hirsutism are polycystic ovary syndrome and idiopathic hirsutism. In hirsutism of gradual onset, hyperprolactinemia, insulin-resistance syndromes, hyperthecosis, polycystic ovary syndrome, and idiopathic hirsutism may be responsible. Cushing's syndrome, neoplasms, and congenital adrenal hyperplasia should be suspected if there has been rapid onset.

Female↗
PubMed1991

[Hirsutism in Chilean women: importance of 21-hydroxylase congenital deficiency of late onset].

The prevalence of steroid 21-hydroxylase (21-OHase) deficiency of late onset was investigated in a Chilean population of hirsute women. In 33 hirsute patients, not family related, plasma 17-alpha hydroxyprogesterone (170H-P) was measured under basal conditions and after ACTH stimulation. Three cases of complete deficiency of late onset or post menarche type were found, a prevalence of 91% similar to that reported by others. Affected patients were indistinguishable from other hirsute women, except in 170H-P concentrations after ACTH. Plasma testosterone and dihydroepiandrosterone sulphate were significantly higher in hirsute women, either deficient of without enzyme deficiency, compared with a control group of 19 normal women. The 170H-P post ACTH levels of hirsute women who did not comply with criteria for enzyme deficiency were similar to control's. However, in these patients there was a significant correlation between hirsutism and 170H-P post ACTH, suggesting the presence of patients with mild enzyme deficiency, perhaps heterozygous for the defective gene. In conclusion, measurement of basal and post ACTH 170H-P during diagnostic work up in hirsute patients allows the detection of a significant number of cases with enzyme deficiency.

17-alpha-Hydroxyprogesterone↗
PubMed1989

Hirsutism--a low dose spironolactone therapy.

Total testosterone, dehydroepiandrosterone sulfate, prolactin and estradiol were assayed in 78 women, clinically divided into idiopathic hirsutism (I. H.)-17 women and polycystic ovary syndrome (PCO) - 61 women, with the latter group having menstrual irregularity dating almost back to the menarche. The serum testosterone measurement was found to be not sensitive in detecting abnormalities in testosterone production. Only 24 (39%) of the women with polycystic ovary syndrome and 5 (29%) of the women with idiopathic hirsutism had elevated serum testosterone. In statistical analysis the serum testosterone was greater (P less than 0.05) in women with polycystic ovary syndrome without hirsutism than in idiopathic hirsutism and PCO with hirsutism. There were not significant differences between the mean levels of prolactin, dehydroepiandrosterone sulfate and estradiol. Twelve women, with hirsutism, were treated with low dose spironolactone (75 mg daily) for six months. There was an excellent clinical response in 7 (58%), incomplete response in one, no response in 4 women. Two patients dropped out of the trial because of ineffectiveness of the therapy after three months. Side effects were not major problem. Spironolactone caused statistically significant reduction in testosterone values after 6 months of treatment. Our results demonstrate that low-dose spironolactone is effective in the treatment of hirsutism.

Adolescent↗
PubMed1982

Hirsutism: diagnostic approach and stimulation-suppression dynamics of androgens in the female.

Total 24-hour urinary 17-ketosteroid (17-KS) and serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured before and after the administration of Cortrosyn and dexamethasone in 46 hirsute and 18 nonhirsute women. Both the baseline urinary 17-KSs and serum androgen levels were significantly higher (P less than 0.05) in hirsute than in nonhirsute subjects. In 58% of the patients in the hirsute group serum androgen concentrations were found to be elevated, while 17-KS levels in 24-hour urine collections were within normal limits. In 87% of our hirsute subjects at least one serum androgen was elevated. Serum DHEA-S concentration was elevated in almost half of the patients with hirsutism. For the evaluation of hyperandrogenism, measurements of serum androgens give more accurate information to the clinician. Dynamic stimulation-suppression studies do not appear to offer any better understanding of the type of androgens involved or a rational guide to the choice of therapy. Hirsute patients were found to be responding less to corticotropin stimulation in comparison to nonhirsute patients. The stimulation rate was significantly higher in 17-KS, A, T, and DHEA-S concentrations in nonhirsute than in hirsute patients.

17-Ketosteroids↗
PubMed1983

Importance of serum androgens chromatography on the acth stimulated adrenal steroidogenesis evaluation in hirsute women.

20 hirsute women ageing between 13-38 and 10 age matched controls were investigated. Steroid pattern (F, 170HP, T, DHEAS, A, DHT) were evaluated after repetitive ACTH administration (0.25 mg every 45' for 135'). Testosterone was assayed either directly in ether serum extract (T) or after a previous silica-gel thin layer chromatography (Tc). Basal serum values of all steroids under investigation were significantly higher in hirsute women than in controls. T values resulted higher than Tc thus stressing the high degree of cross-reactivity among DHT, DHEAS, A and T in unchromatographed serum steroid RIA. On the other hand ACTH repeated administration elicited an earlier and more significant T value increase in normals than in hirsutes, whereas Tc did not show any significant change in either group. Similarly DHT serum values did not vary after repetitive ACTH administration either in controls or in hirsute women. During ACTH test A serum values enhanced at 45' in both controls and hirsute women without any further increase after ACTH injections, whereas a lower degree of DHEAS enhancement during ACTH test was observed. On the contrary both F and 17-OHP plasma values strongly enhanced at 45' but a further increase of their values after every ACTH stimulus was also observed. Our data seem to confirm the enhanced adrenal steroidogenesis in hirsutism. But the adrenal contribution to enhanced androgen serum pattern of hirsute women appears to be more evident in androstenedione than in the testosterone fraction.

Adolescent↗
PubMed1982

Plasma free and protein-bound testosterone in hirsutism.

Blood samples were obtained from 145 preovulatory and postovulatory hirsute women and the plasma was analyzed for total testosterone (T), T index, and free T concentration as well as the fraction of free T percentage and that bound by testosterone-estradiol binding globulin. Fifty-six patients were subjected to a 2-week dexamethasone (DXM) suppression test to delineate the source of androgen excess. Presuppression and postsuppression samples were also analyzed for plasma T concentrations and its free and bound fractions. The total T, T index, and free T were elevated in 58, 66, and 55% of hirsute women, respectively. The percentage of bound T fraction was decreased in only 39% of hirsute women, whereas the percentage of free T fraction was increased in 30% and decreased in 11% of hirsute women. The postovulatory hirsute women had a normal percentage of free and bound T fractions, although their total plasma concentrations were elevated. They also had a lower frequency of abnormal levels in all T measurements than preovulatory hirsute women. The DXM seems to deplete the plasma binding globulin; thus the bound T fractions in the post-DXM samples were lower than the pre-DXM values. The total T may be a better measure than the free T values in evaluation of the DXM suppression test for hirsute women.

Adrenal Glands↗