title: Increased urinary free cortisol and decreased serum corticosteroid-binding globulin in polycystic ovary syndrome.
abstract: The adrenal participation in the pathogenesis of polycystic ovary syndrome is still under debate. In order to reappraise androgen and glucocorticoid secretion in this disease, we measured serum androstenedione, dehydroepiandrosterone-sulphate, total and free testosterone, sex hormone-binding globulin, LH, FSH, PRL, cortisol, corticosteroid-binding globulin, and urinary free cortisol in 45 women with polycystic ovary syndrome and 27 controls, subdivided in obese and normal-weight subjects. Androstenedione, total and free testosterone were significantly increased, whereas sex hormone-binding globulin tended to be reduced in patients with polycystic ovary syndrome compared with controls, reaching a significant difference between obese patients and matched controls. Free testosterone and sex hormone-binding globulin were significantly increased and reduced, respectively, in obese compared with normal-weight patients. Urinary free cortisol and serum corticosteroid-binding globulin were significantly increased (p less than 0.001) and decreased (p less than 0.005), respectively. Urinary free cortisol exceeded the upper limit of the normal range in 50% of our patients. No appreciable differences were found in PRL and cortisol levels. Besides confirming a hyperandrogenic state, our findings point to an overactivity of the hypothalamic-pituitary-adrenal axis with subsequent diminution of corticosteroid-binding globulin in polycystic ovary syndrome. They also indicate that urinary free cortisol is not a reliable index in differentiating polycystic ovary syndrome from Cushing's disease.
authors.affiliation: First Medical Clinic, University of Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Invitti
authors.forename: F
authors.initials: F
authors.lastname: Pecori Giraldi
authors.forename: A
authors.initials: A
authors.lastname: Dubini
authors.forename: M
authors.initials: M
authors.lastname: De Martin
authors.forename: F
authors.initials: F
authors.lastname: Cavagnini
mesh_terms: D000328:Adult; D000728:Androgens / Q000097:blood; D005260:Female; D005938:Glucocorticoids / Q000097:blood; D006728:Hormones / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D009765:Obesity / Q000097:blood; D009994:Osmolar Concentration; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000652:urine*; D012016:Reference Values; D014156:Transcortin / Q000032:analysis*
chemical_list: D000728:Androgens; D005938:Glucocorticoids; D006728:Hormones; D014156:Transcortin; D006854:Hydrocortisone