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NEUROENDOCRINOLOGY LETTERS
including Psychoneuroimmunology, Neuropsychopharmacology,
Reproductive Medicine, Chronobiology
and Human Ethology, ISSN 0172–780X

NEL Vol.24 Nos.3/4, Jun-Aug 2003

ORIGINAL ARTICLE

Running Title:
Pituitary-adrenal axis in PCOS

2003; 24:249254
pii: NEL243403A16
PMID: 14523365

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Evaluation of the Pituitary-adrenal axis in hyperandrogenic women with polycystic ovary syndrome

Rafael Luboshitzky 1,3, Abraham Ishai 1, Zila Shen-Or 2 & Paula Herer 3

1. Endocrine Institute, Haemek Medical Center, Afula (RL, AI),
2. Endocrine Laboratory, Rambam Medical Center, Haifa (ZSO), and
3. the B.Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

Submitted: February 24, 2003
Accepted: March 12, 2003

Key words:
ACTH test, cortisol, 17-hydroxyprogesterone, polycystic ovary syndrome

 

Abstract

Objectives: Impaired adrenal function is common in patients with polycystic ovary syndrome (PCOS). Abnormal regulation of cytochrome P450 17 alpha is believed to cause the exaggerated 17-hydroxyprogesterone (17OHP) response to ACTH stimulation. The aim of the study was to evaluate cortisol and 17OHP response to low dose (1 mg) ACTH test and to compare it with the standard ACTH (250 mg) test in hyperandrogenic women with PCOS.

Design and measurements: We studied 27 PCOS and 22 control women. All participants were examined for mutations of the CYP21 gene, Cortisol and 17OHP levels before, 30 and 60 minutes after the IV injection of 250 mg ACTH (SDT) and after 1 mg ACTH (LDT). Fasting serum levels of LH, FSH, testosterone, DHEAS were determined in all participants.
Results: Basal and ACTH stimulated Cortisol during the SDT (470±138 nmol/L and 761±143, respectively) were significantly higher in PCOS vs. controls (232±124 and 670±130, respectively) (p<0.03, p<0.02, respectively). Basal 17OHP (6.1±2.1 nmol/L) and the peak response to SDT (14.2±3.6 nmol/L) were significantly higher in PCOS vs. controls (4.2±2.1, 10.9±3.0, respectively) (p<0.003, p<0.004, respectively). Abnormally elevated 17OHP response to SDT was detected in 6/27 PCOS women (22%). No statistically significant difference between the PCOS and control groups were noted during the LDT in both cortisol and 17OHP levels.

Conclusions: These data suggest that the exaggerated 17-hydroxypro­geste­rone (17OHP) response to ACTH stimulation in PCOS is revealed by stimulation at a pharmacological dose (250 mg) but not by a physiological dose (1 mg).

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Society of Integrated Sciences
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