Adrenocortical hyperresponsiveness to corticotropin in polycystic ovary syndrome patients with adrenal androgen excess

Fertil Steril. 2004 Jan;81(1):126-31. doi: 10.1016/j.fertnstert.2003.07.008.


Objective: To test the hypothesis that adrenal androgen (AA) excess in the polycystic ovary syndrome (PCOS) is due to a generalized exaggeration in AA output in response to adrenocorticotropic hormone (ACTH), and that this abnormality is due to an identifiable alteration in the biosynthesis of AAs.

Design: Cross-sectional prospective controlled study.

Setting: Academic tertiary care medical center.

Patient(s): Patients with PCOS (n = 9) and without (n = 9) AA excess and controls (n = 12) without hyperandrogenism, matched for age and body mass.

Intervention(s): Acute 60-minute ACTH test was performed on patients.

Main outcome measure(s): Basal levels of dehydroepiandrosterone sulfate (DHEAS), total testosterone (T), free T, and basal (Steroid(0)) and the 60-minute ACTH-stimulated levels (Steroid(60)) of pregnenolone (PREG), progesterone (P4), 17-hydroxypregnenolone (17-HPREG), 17-hydroxyprogesterone (17-HP), dehydroepiandrosterone (DHEA), and androstenedione (A4) were measured. Adrenocortical activities of 17-hydroxylase (17-OH), 17,20-lyase, and 3beta-hydroxysteroid dehydrogenase were estimated from product to precursor ratio, using Steroid(60) values.

Result(s): Compared with PCOS patients without AA excess, PCOS patients with AA excess demonstrated significantly greater levels of DHEA(0) and A4(60). PCOS patients with AA excess had significantly higher activity of delta(5)17-OH, compared with PCOS patients without AA excess.

Conclusion(s): Adrenal androgen excess in PCOS is associated with a greater delta(5)17-OH activity in response to ACTH.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 17-alpha-Hydroxyprogesterone / blood
  • 3-Hydroxysteroid Dehydrogenases / blood
  • Adrenal Cortex / drug effects
  • Adrenal Cortex / metabolism*
  • Adrenocorticotropic Hormone / metabolism*
  • Adrenocorticotropic Hormone / pharmacology
  • Adult
  • Androstenedione / blood
  • Case-Control Studies
  • Cross-Sectional Studies
  • Dehydroepiandrosterone / blood
  • Dehydroepiandrosterone Sulfate / blood
  • Female
  • Humans
  • Hyperandrogenism / metabolism
  • Polycystic Ovary Syndrome / drug therapy
  • Polycystic Ovary Syndrome / metabolism*
  • Polycystic Ovary Syndrome / physiopathology
  • Pregnenolone / blood
  • Progesterone / blood
  • Prospective Studies
  • Steroid 17-alpha-Hydroxylase / blood
  • Testosterone / blood


  • Testosterone
  • Androstenedione
  • Dehydroepiandrosterone
  • Progesterone
  • Dehydroepiandrosterone Sulfate
  • 17-alpha-Hydroxyprogesterone
  • Pregnenolone
  • Adrenocorticotropic Hormone
  • 3-Hydroxysteroid Dehydrogenases
  • Steroid 17-alpha-Hydroxylase