Abstract
Many hirsute women may present a form of functional ovarian hyperandrogenism (FOH), since they show an exaggerated 17-hydroxyprogesterone (17-OHP) response to GnRH agonists administration. As the failure of dexamethasone to reduce testosterone levels may be indicative of an ovarian source of androgen secretion, we evaluated the usefulness of dexamethasone suppression test, in comparison with buserelin challenge, in the assessment of hirsutism. Twenty-seven hirsute women (aged 15–42 yr) underwent ACTH and buserelin tests: 4 patients were heterozygotes for 21-OH deficiency and 8 patients were affected with FOH: 2 of the patients with hyperresponse to buserelin also had 21-hydroxylase deficiency. The results of the dexamethasone suppression test (2 mg/day for 7 days) were compared to those obtained after buserelin test. Basal T and Δ4 levels (mean±SE) were higher than in controls (4.2±0.5 vs 2.2±0.2 nmol/l and 10.9±0.9 vs 5.9±0.6 nmol/l, p<0.02), while no differences were found in 17-OHP and DHEAS levels. A significant reduction (p<0.001) in T (1.8±0.4 nmol/l), Δ4 (3.2±0.5 nmol/l) and DHEAS levels (2.4±0.3 μmol/l) was observed at the 3rd day of dexamethasone administration and no differences between sampling at 3rd, 5th and 7th day were found. Serum T was not suppressed in 6 cases, Δ? and DHEAS levels in 3 and 1 of them, respectively. Buserelin injection caused an excessive 17-OHP response in 8 patients, only 4 of them did not reduce T levels during dexamethasone. The sensitivity and specificity of the dexamethasone suppression test, with respect to the buserelin test, were 50% and 89%, respectively. In conclusion, 37% of hirsute patients had an abnormal responsiveness to buserelin and/or ACTH tests, indicating that hormonal investigations are mandatory. An ovarian origin of hirsutism was identified by buserelin test in 30% of patients and by dexamethasone in 22% of cases; only 4 of 8 patients showed concordant results to both tests. Therefore, buserelin challenge seems a more useful, cost-effective and less time consuming tool than dexamethasone administration in order to recognize the possible ovarian origin of hyperandrogenism.
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Zawadki J.K., Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A., Givens J.R., Haseltine F., Merriam G.R., (Eds.), Polycystic ovary syndrome. Blackwell, Boston, 1992, pp. 377–384.
Barnes R.B., Rosenfield R.L., Burstein S., Ehrmann D.A. Pituitary-ovarian responses to nafarelin testing in the polycystic ovary syndrome. N. Engl. J. Med. 1989, 320: 559–565.
Ehrmann D.A., Rosenfield R.L., Barnes R.B., Brigell D.F., Shei K Z. Detection of functional hyperandrogenism in women with androgen excess. N. Engl. J. Med. 1992, 327: 157–162.
Kirschner M.A., Zucker I.R., Jespersen D. Idiopathic hirsutism—An ovarian abnormality. N. Engl. J. Med. 1976, 294: 637–640.
Karpas A.E., Roudriguez-Rigau L.J., Smith K.D., Steinberger E. Effect of acute and chronic androgen suppression by glucocorticoids on gonadotropin levels in hirsute women. J. Clin. Endocrinol. Metab. 1984, 59: 780–784.
Barnes R., Rosenfield R.L. The polycystic ovary syndrome: pathogenesis and treatment. Ann. Intern. Med. 1989, 100: 386–399.
Ferriman D., Gallwey J.D. Clinical assessment of body hair growth in women. J. Clin. Endocrinol. Metab. 1961, 721: 1440–1447.
New M.I., Lorenzen F., Lerner A.J., Kohn B., Oberfield S.E., Pollack, M.S., Dupont B., Stoner E., Levy D.J., Pang S., Levine L.S. Genotyping steroid 21-hydroxylase deficiency: hormonal reference data. J. Clin. Endocrinol. Metab. 1983, 57: 320–326.
Ambrosi B., Re T., Passini E., Bochicchio D., Ferrario R. Value of buserelin testing in the evaluation of hirsute women. J. Endocrinol. Invest. 1996, 19: 204–209.
Ibanez L., Potau N., Zampolli M., Prat N., Gussinye M., Saenger P., Vinces-Calvet, Carrascosa A. Source localization of androgen excess in adolescent girls. J. Clin. Endocrinol. Metab. 1994, 79: 1778–1784.
Eldar-Geva T., Hurwitz A., Vecsei P., Palti Z., Milwidsky A., Rosler A. Secondary biosynthetic defects in women with lateonset congenital adrenal hyperplasia. N. Engl. J. Med. 1990, 323: 855–863.
Turner E.I., Wastn M.J., Perry L.A., White M.C. Investigation of adrenal function in women with oligomenorrhea and hirsutism (clinical PCOS) from the North-East of England using an adrenal stimulation test. Clin. Endocrinol. (Oxf.) 1992, 36: 389–397.
McLaughlin B, Barret P., Finch T., Devlin J.G. Late onset adrenal hyperplasia in a group of Irish females who presented with hirsutism, irregular menses and/or cystic acne. Clin. Endocrinol. (Oxf.) 1990, 36: 57–64.
White D., Leigh A., Wilson C., Donaldson A., Franks S. Gonadotrophin and gonadal steroid response to a single dose of long-acting agonist of gonadotrophinreleasing hormone in ovulatory and anovulatory women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 1995, 42: 475–481.
Sahin Y., Kelestimur F. 17-hydroxyprogesterone response to buserelin testing in the polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 1993, 39: 151–155.
Ehrmann D.A., Barnes R.B., Rosenfield R.L. Polycystic ovary syndrome as a form of functional ovarian hyperandrogenism due to dysregulation of androgen secretion. Endocr. Rev. 1995, 16: 322–353.
Gilling-Smith C., Willis D.S., Beard R.W., Franks S. Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries. J. Clin. Endocrinol. Metab. 1994, 79: 1158–1165.
Gilling-Smith C., Stry H., Rogers V., Franks S. Evidence for a primary abnormality of thecal cell steroidogenesis in the polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 1997, 47: 93–99.
Barnes R.B. The pathogenesis of polycystic ovary syndrome: Lessons from ovarian stimulation studies. J. Endocrinol. Invest. 1998, 21: 567–579.
Carmina E., Lobo R.A. Adrenal hyperandrogenism in the pathophysiology of polycystic ovary syndrome. J. Endocrinol. Invest. 1998, 21: 580–588.
Barnes R., Rosenfield R.L. The polycystic ovary syndrome: pathogenesis and treatment. Ann. Intern. Med. 1989, 110: 386–399.
Rosner W. Errors in the measurement of plasma free testosterone. J. Clin. Endocrinol. Metab. 1997, 82: 2014–2015.
Barnes R.B., Rosenfield R.L., Ehrmann D.A. Dexamethasone suppression testing is a reliable predictor of ovarian but not of adrenal hyperandrogenism. The Endocrine Society, 77th Annual Meeting, Washington, June 1995, pp. 2–81 (abs).
Azziz R., Black V., Hines G.A., Fox L.M., Boots L.R. Adrenal androgen excess in the polycystic ovary syndrome: sensitivity and responsivity of the hypothalamic- pituitary-adrenal axis. J. Clin. Endocrinol. Metab. 1998, 83: 2317–2323.
Azziz R., Dewailly D., Owerbach D. Nonclassic adrenal hyperplasia: Current concepts. J. Clin. Endocrinol. Metab. 1994, 78: 810–815.
Wilke T.J., Ultey D.J. Total testosterone, free androgen index, calculated free testosterone and free testosterone by analog RIA compared in hirsute women and otherwise normal women with altered binding of sex-hormone binding globulin. Clin. Chem. 1987, 33(8): 1372–1375.
Rossi R., Tauchmanovà L., Luciano A., Valentino R., Savastano S., Battista C., Di Martino M., Lombardi G. Functional hyperandrogenism detected by corticotropin and GnRH-analogue stimulation tests in women affected by apparently idiopathic hirsutism. J. Endrocrinol. Invest. 2001, 24: 491–498.
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Re, T., Barbetta, L., Dall’Asta, C. et al. Comparison between buserelin and dexamethasone testing in the assessment of hirsutism. J Endocrinol Invest 25, 84–90 (2002). https://doi.org/10.1007/BF03343965
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DOI: https://doi.org/10.1007/BF03343965