Role of the ovary in the adrenal androgen excess of hyperandrogenic women

Ricardo Azziz, Roger S. Rittmaster, Leisl M. Fox, Edwin L. Bradley, H. Downing Potter, Larry R. Boots

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objective: To test the hypothesis that ovarian hormones in women with hyperandrogenism alter adrenocortical steroidogenesis. Design: Combination of two prospective studies. Setting: Academic medical centers. Patient(s): Eighteen hyperandrogenic patients demonstrating hirsutism with either hyperandrogenemia, oligomenorrhea, or both. Eighteen healthy nonhirsute eumenorrheic untreated women served as controls. Interventions: Blood sampling basally and after acute adrenal stimulation with ACTH, before and after 20-24 weeks of leuprolide administration. Nine patients also received 0.625 mg/d of oral conjugated esterified estrogens and 10 mg of medroxyprogesterone acetate days 1-12 of the month (i.e., estrogen replacement therapy [ERT]), whereas the remaining nine did not. Main Outcome Measure(s): Before and after the administration of the GnRH agonist (GnRH- a), the basal concentrations of DHEAS; and the levels of androstenedione (A4), DHEA, androstenediol, 11β-hydroxyandrostenedione (11-OHA4), and cortisol before and 60 minutes after acute adrenal stimulation, were measured. Result(s): Levels of DHEAS, androstenediol, and 11-OHA4 decreased by 15%30%, regardless of whether patients initially had or did not have DHEAS excess. However, only hyperandrogenic patients with elevated levels of DHEAS showed a significant decrease in basal DHEA levels. No statistically significant difference in the response of either androgen to ACTH (1-24) stimulation was noted with ovarian suppression, regardless of initial DHEAS level or use of ERT. Conclusion(s): We found no evidence that ovarian hormone secretion affected adrenal steroidogenesis, and those women with the highest adrenal androgen levels had the least response to GnRH-a suppression. These findings further support the concept of an intrinsic, and possibly primary, abnormality of adrenocortical steroidogenesis in a subset of hyperandrogenic women that is independent of ovarian abnormalities.

Original languageEnglish (US)
Pages (from-to)851-859
Number of pages9
JournalFertility and sterility
Issue number5
StatePublished - May 1998


  • Adrenal
  • Androgens
  • Gonadotropin- releasing hormone analogues
  • Hirsutism
  • Polycystic ovary syndrome

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology


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