Martikainen H, Salmela P, Nuojua-Huttunen S, Perälä J, Leinonen S, Knip M, Ruokonen A
Department of Obstetrics and Gynecology, University Central Hospital of Oulu, Finland.
Fertil Steril. 1996 Oct;66(4):564-70. doi: 10.1016/s0015-0282(16)58568-9.
To evaluate ovarian and adrenal steroid secretion in women with severe hyperandrogenism.
A prospective study.
The Gynecological Endocrine Research Unit of the University Central Hospital, Oulu, Finland.
Thirteen obese, hirsute women with severe hyperandrogenism.
Adrenocorticotropin hormone stimulation and dexamethasone suppression tests and selective catheterizations of the left ovarian and adrenal veins were performed.
The concentrations of insulin, P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, DHEA, DHEAS, and cortisol were measured.
The secretory gradients of T and its precursors, P, 17-OHP, A, and DHEA in the selective catheterizations showed the adrenal to be the main source of excessive steroid production in these patients. The concentrations of P (r = 0.82), 17-OHP (r = 0.89), A (r = 0.84), T (r = 0.86), and cortisol (r = 0.87) in the adrenal vein showed a strong correlation with insulin measured from the same samples.
Excessive androgens were secreted mainly by the adrenals in these obese hyperinsulinemic women. Correlation analyses suggested that insulin stimulates adrenal androgen and cortisol secretion, which may constitute an important component of the pathogenetic mechanisms of hyperandrogenism and the polycystic ovary syndrome.
评估重度高雄激素血症女性的卵巢和肾上腺类固醇分泌情况。
一项前瞻性研究。
芬兰奥卢大学中心医院妇科内分泌研究室。
13名肥胖、多毛且患有重度高雄激素血症的女性。
进行促肾上腺皮质激素刺激试验、地塞米松抑制试验以及左侧卵巢静脉和肾上腺静脉的选择性插管。
测量胰岛素、孕酮（P）、17-羟孕酮（17-OHP）、雄烯二酮（A）、睾酮（T）、脱氢表雄酮（DHEA）、硫酸脱氢表雄酮（DHEAS）和皮质醇的浓度。
选择性插管中T及其前体P、17-OHP、A和DHEA的分泌梯度表明，肾上腺是这些患者类固醇过度分泌的主要来源。肾上腺静脉中P（r = 0.82）、17-OHP（r = 0.89）、A（r = 0.84）、T（r = 0.86）和皮质醇（r = 0.87）的浓度与同一样本中测得的胰岛素呈强烈相关性。
在这些肥胖的高胰岛素血症女性中，过量雄激素主要由肾上腺分泌。相关性分析表明，胰岛素刺激肾上腺雄激素和皮质醇分泌，这可能是高雄激素血症和多囊卵巢综合征发病机制的重要组成部分。
