Fulghesu A M, Lanzone A, Fortini A, Guido M, Caruso A, Mancuso S
Department of Obstetrics and Gynecology, Universitá Cattolica del Sacro Cuore, Rome, Italy.
J Reprod Med. 1993 May;38(5):387-92.
Ovarian and adrenal production of androgens was evaluated in 18 patients with polycystic ovary syndrome (PCOS) by administering a combination of short-term dexamethasone (DEX) and long-term gonadotropin-releasing hormone agonist (GnRH-A). At day 6 of the cycle, blood samples were collected at 7 A.M. (basal) and 11 P.M. At midnight, 2 mg DEX was given orally, and blood samples were collected at 7 A.M. the following day (DEX1). Blood samples were obtained for 6 weeks at the same time after administration of a potent GnRH-A (400 micrograms/day given subcutaneously). Eight normal subjects served as controls. The amounts of androgens and 17-hydroxyprogesterone (17-OHP) suppressed by using DEX (adrenal-source suppression) and GnRH-A (ovarian-source suppression) were greater in PCOS patients than in controls. We differentiated PCOS patients as having a normal or an exaggerated response to DEX or GnRH-A administration; threshold values were considered average +2SD of the suppressed androgen amounts of controls. Three patients had an exaggerated response to GnRH-A treatment for androstenedione, testosterone and 17-OHP, while DEX inhibition was similar to controls. The remaining 15 patients had an exaggerated response to DEX for all three androgens; seven also had an exaggerated response to GnRH-A. Thus, the combination of GnRH-A and DEX permitted us to selectively study and identify adrenal and ovarian sources of hyperandrogenemia.
通过联合使用短期地塞米松（DEX）和长期促性腺激素释放激素激动剂（GnRH - A），对18例多囊卵巢综合征（PCOS）患者的卵巢和肾上腺雄激素生成情况进行了评估。在月经周期的第6天，于上午7点（基础值）和晚上11点采集血样。午夜口服2毫克地塞米松，并于次日上午7点采集血样（DEX1）。在给予强效GnRH - A（皮下注射400微克/天）后，连续6周在同一时间采集血样。8名正常受试者作为对照。PCOS患者中，使用DEX（肾上腺来源抑制）和GnRH - A（卵巢来源抑制）所抑制的雄激素和17 - 羟孕酮（17 - OHP）量高于对照组。我们将PCOS患者分为对地塞米松或GnRH - A给药反应正常或过度的类型；阈值被认为是对照组抑制雄激素量的平均值 + 2标准差。3例患者对GnRH - A治疗的雄烯二酮、睾酮和17 - OHP反应过度，而地塞米松抑制作用与对照组相似。其余15例患者对所有三种雄激素的地塞米松抑制反应过度；其中7例对GnRH - A的反应也过度。因此，GnRH - A和地塞米松的联合使用使我们能够选择性地研究和确定高雄激素血症的肾上腺和卵巢来源。
