Bilateral Adrenal Hyperplasia as a Possible Mechanism for Hyperandrogenism in Women With Polycystic Ovary Syndrome

J Clin Endocrinol Metab. 2016 Sep;101(9):3353-60. doi: 10.1210/jc.2015-4019. Epub 2016 Jun 23.


Context: Androgen excess may be adrenal and/or ovarian in origin; we hypothesized that a subgroup of patients with polycystic ovarian syndrome (PCOS) may have some degree of abnormal adrenocortical function.

Objective: The objective of the study was to evaluate the pituitary adrenal axis with an oral low- and high-dose dexamethasone-suppression test (Liddle's test) in women with PCOS.

Design: This was a case-control study.

Setting: The study was conducted at the National Institutes of Health Clinical Center.

Participants: A total of 38 women with PCOS and 20 healthy volunteers (HV) aged 16-29 years participated in the study.

Main outcome measures: Urinary free cortisol (UFC) and 17-hydroxysteroids (17OHS) before and after low- and high-dose dexamethasone and assessment of adrenal volume by computed tomography scan were measured.

Results: Twenty-four-hour urinary 17OHS and UFC were measured during day 1 to day 6 of the Liddle's test. Baseline UFC levels were not different between PCOS and HVs; on the day after the completion of high-dose dexamethasone administration (d 6), UFC was higher in the PCOS group (2.0 ± 0.7 μg/m(2)·d) than the HV group (1.5 ± 0.5) (P = .038). On day 5, 17OHS and UFC were negatively correlated with adrenal volumes (left side, rp = -0.47, P = .009, and rp = -0.61, P < .001, respectively). PCOS patients above the 75th percentile for UFC and/or 17OHS after high-dose dexamethasone (n = 15) had a significantly smaller total adrenal volume (6.9 ± 1.9 cm(3) vs 9.2 ± 1.8 cm(3), P = .003) when compared with the remaining PCOS patients (n = 22), but they did not have worse insulin resistance or hyperandrogenism.

Conclusions: In a subset of young women with PCOS, we detected a pattern of glucocorticoid secretion that mimicked that of patients with micronodular adrenocortical hyperplasia: they had smaller adrenal volumes and higher steroid hormone secretion after dexamethasone compared with the group of PCOS with appropriate response to dexamethasone.

Trial registration: NCT01313455.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adrenal Glands / metabolism
  • Adrenal Glands / pathology*
  • Adult
  • Androgens / metabolism
  • Biomarkers / metabolism
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperandrogenism / etiology*
  • Hyperandrogenism / metabolism
  • Hyperandrogenism / pathology
  • Hyperplasia / metabolism
  • Hyperplasia / pathology*
  • Polycystic Ovary Syndrome / complications*
  • Polycystic Ovary Syndrome / metabolism
  • Polycystic Ovary Syndrome / pathology
  • Prognosis
  • Young Adult


  • Androgens
  • Biomarkers

Associated data