Azziz R, Rafi A, Smith B R, Bradley E L, Zacur H A
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
J Clin Endocrinol Metab. 1990 Feb;70(2):431-6. doi: 10.1210/jcem-70-2-431.
Hyperandrogenic women appear to demonstrate an exaggerated 17-hydroxyprogesterone (17-HP) response to adrenal stimulation which is not due to the marked 21-hydroxylase deficiency of late-onset adrenal hyperplasia (LOAH). Furthermore, in hyperandrogenism the ovary also appears to secrete excessive amounts of 17-HP. It is not clear to what extent the elevated 17-HP levels after ACTH stimulation are due to extraadrenal production of the steroid. This investigation was undertaken to assess the adrenal contribution to the elevated 17-HP levels after ACTH stimulation observed in non-LOAH hyperandrogenism. One hundred and sixty consecutive unselected women with hirsutism and/or hyperandrogenic oligomenorrhea formed the clinical population. Excluded were 4 women with LOAH and all patients with hyperprolactinemia. For the purpose of investigating the relationship between adrenal response and clinical symptoms, hyperandrogenic patients were divided into 3 subgroups: hirsute only (n = 23), hirsute oligomenorrheic (n = 84), and oligomenorrheic only (n = 24). Subclassification for an additional 29 patients (18%) with hyperandrogenemia was not possible, since their symptomatology was not clearly stated in the record. However, these individuals were included in the patient group as a whole. Controls consisted of 21 healthy, regularly menstruating, nonhirsute female volunteers. Both patients and controls underwent acute adrenal stimulation with 1 mg ACTH-(1-24), and serum was obtained before and 30 min after ACTH administration. Hyperandrogenic patients had higher mean basal total testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHS), 17-HP, and LH/FSH levels, but not cortisol (F), compared to normal subjects (P less than 0.02). Oligomenorrheic only women had higher mean A and progesterone (P) levels than other hyperandrogenic patients (P less than 0.02). No correlation was noted between body mass index (BMI) and the levels of DHS, P, or A, while a weak positive association was noted between the BMI and the mean T (r = 0.31; P less than 0.002) and a weak negative correlation between the mean F and BMI (r = -0.21; P less than 0.05). The mean 17-HP level 30 min after ACTH administration (17-HP30) was significantly higher in hyperandrogenic women than in normal subjects whether analyzed in separate subgroups or together and was due to the higher basal 17-HP levels. Basal 17-HP correlated with the circulating levels of T, A, and P, steroids largely of ovarian origin. Alternatively, the net increment in 17-HP from 0-30 min after ACTH (delta 17-HP30) was not significantly higher in hyperandrogenic women than normal subjects and did not correlate with the basal levels of T, A, and P. Neither the basal level of 17-HP nor its response to ACTH correlated with circulating DHS levels.(ABSTRACT TRUNCATED AT 400 WORDS)
高雄激素血症女性似乎对肾上腺刺激表现出夸大的17-羟孕酮（17-HP）反应，这并非由于迟发性肾上腺增生（LOAH）明显的21-羟化酶缺乏所致。此外，在高雄激素血症中，卵巢似乎也分泌过量的17-HP。促肾上腺皮质激素（ACTH）刺激后17-HP水平升高在多大程度上归因于肾上腺外类固醇的产生尚不清楚。本研究旨在评估肾上腺对非LOAH高雄激素血症中ACTH刺激后17-HP水平升高的作用。连续160例未经选择的多毛症和/或高雄激素性稀发月经女性构成临床研究人群。排除4例LOAH女性和所有高催乳素血症患者。为了研究肾上腺反应与临床症状之间的关系，高雄激素血症患者被分为3个亚组：仅多毛（n = 23）、多毛伴稀发月经（n = 84）和仅稀发月经（n = 24）。另外29例（18%）高雄激素血症患者由于记录中症状描述不明确无法进行亚分类。然而，这些个体被纳入整个患者组。对照组由21名健康、月经规律、无多毛的女性志愿者组成。患者和对照组均接受1mg ACTH-（1-24）的急性肾上腺刺激，并在ACTH给药前和给药后30分钟采集血清。与正常受试者相比，高雄激素血症患者的平均基础总睾酮（T）、雄烯二酮（A）、硫酸脱氢表雄酮（DHS）、17-HP和LH/FSH水平较高，但皮质醇（F）水平无差异（P<0.02）。仅稀发月经的女性平均A和孕酮（P）水平高于其他高雄激素血症患者（P<0.02）。体重指数（BMI）与DHS、P或A水平之间无相关性，而BMI与平均T之间存在弱正相关（r = 0.31；P<0.002），平均F与BMI之间存在弱负相关（r = -0.21；P<0.05）。无论单独分析亚组还是一起分析，ACTH给药后30分钟的平均17-HP水平（17-HP30）在高雄激素血症女性中均显著高于正常受试者，这是由于基础17-HP水平较高所致。基础17-HP与T、A和P的循环水平相关，这些类固醇主要来源于卵巢。或者，ACTH后0至30分钟17-HP的净增量（Δ17-HP30）在高雄激素血症女性中并不显著高于正常受试者，且与T、A和P的基础水平无关。17-HP的基础水平及其对ACTH的反应均与循环DHS水平无关。（摘要截断于400字）
