[Defects of adrenal steroidogenesis in patients with hirsutism].
BACKGROUND
To determine the frequency and the type of adrenal steroidogenic abnormalities in hirsute women.


METHODS
ACTH test was performed during follicular phase in 127 hirsute and 40 normal (control) women. Before ACTH injection we measured in serum by RIA: 17-OH-pregnenolone (17-OH-P5), 17-OH-progesterone (17-OH-P4), androstenedione (AN), cortisol (CT), 11-deoxycortisol (DCT), dehydroepiandrosterone (DHEA) and its sulphate (DHEAS), total (TT) and free (FT) testosterone, oestradiol (E2), progesterone (PR), androstenediol glucuronide (AG), LH, FSH and prolactin. After 60 min of ACTH injection 17-OH-P5, 17-OH-P4, AN, DHEA, CT and DCT were measured. Net increment of stimulated steroids and the ratios 17-OH-P5/17-OH-P4, DHEA/AN, 17-OH-P4/CT, 17-OH-P5/CT and DCT/CT were calculated. Pelvic ultrasonographic exploration was done when irregular menses were reported.


RESULTS
Up to 31% of the patients presented enzymatic defects in adrenal steroidogenesis. Diagnostic criteria for enzyme defects were established. Late-onset 21-hydroxylase deficiency was diagnosed in 6 (4.5%) patients, HLA typing of these patients demonstrated that 4 out of 6 had B14-DR1. Sixteen women (12.6%) displayed a 17-OH-P4 response and the net increment 2 SD above the normal mean concentration, which are diagnostic criteria for late-onset 21-hydroxylase deficiency carriers. We diagnosed a 3 beta-hydroxysteroid dehydrogenase defect when 17-OH-P5 and DHEA responses, their net increment and the 17-OH-P5/17-OH-P4 and 17-OH-P5/CT ratios were 2 SD above the normal mean after ACTH: 14 women were diagnosed. 11 beta-hydroxylase deficiency diagnosis was made when DCT response, its net increment and the DCT/CT ratio after ACTH were 2 SD above the normal mean: 7 women were detected. Associated biosynthetic defects were described.


CONCLUSIONS
One third of our patients with hirsutism presented anomalous response to ACTH, consistent with enzymatic abnormalities in adrenal steroidogenesis.
Salinas Vert
I
I
Servicio de Endocrinologia, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona.
Audí Parera
L
L
Granada Ybern
M L
ML
Lucas Martín
A
A
Pizarro Lozano
E
E
Foz Sala
M
M
Sanmartí Sala
A
A
D006907:17-alpha-Hydroxypregnenolone / Q000097:blood; D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000096:biosynthesis*; D000312:Adrenal Hyperplasia, Congenital; D000324:Adrenocorticotropic Hormone; D000328:Adult; D045930:Anabolic Agents / Q000097:blood; D015114:Androstenediol / Q000097:blood; D000735:Androstenedione / Q000096:biosynthesis / Q000097:blood; D003350:Cortodoxone / Q000097:blood; D003687:Dehydroepiandrosterone / Q000096:biosynthesis / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006628:Hirsutism / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis / Q000097:blood; D006913:Hydroxysteroid Dehydrogenases / Q000097:blood*; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle; D008875:Middle Aged; D011374:Progesterone / Q000097:blood; D011388:Prolactin / Q000097:blood; D011863:Radioimmunoassay; D013739:Testosterone / Q000097:blood
D000305:Adrenal Cortex Hormones; D045930:Anabolic Agents; D006907:17-alpha-Hydroxypregnenolone; D013739:Testosterone; D000735:Androstenedione; D003687:Dehydroepiandrosterone; D011374:Progesterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D015114:Androstenediol; D006913:Hydroxysteroid Dehydrogenases; D003350:Cortodoxone; D006854:Hydrocortisone