Disturbances of androgen secretion and metabolism in polycystic ovary syndrome.

No matter how we define PCO, it is a heterogeneous clinical disorder. The common denominators of this and other overlapping clinical syndromes are the findings of chronic anovulation and androgen excess. Frequently, but not always, these events lead to cystic ovarian changes. The hyperandrogenism may be documented by finding elevated blood levels of ovarian or adrenal androgens or both in combination. The manifestation of this hyperandrogenism, however, is determined by separate factors. It is the degree of 5 alpha-reductase activity in tissues that appears to govern the manifestation of androgen excess. This increased metabolism may be reflected by an in vitro assay of skin 5 alpha-reductase activity or serum levels of 3 alpha-diol G. While 30% of patients with PCO may not have hirsutism, their serum androgen levels are similar to other hirsute patients. Hirsute and nonhirsute patients with PCO may be differentiated by their degree of peripheral androgen metabolism, specifically by their serum levels of 3 alpha-diol G.