Classification of polycystic ovary syndrome into three types according to response to human corticotropin-releasing hormone.
OBJECTIVE
To evaluate disturbances of the hypothalamic-pituitary-adrenal axis in women with polycystic ovary syndrome (PCOS).


METHODS
Retrospective cohort study.


METHODS
Yokohama City University, Yokohama, Japan.


METHODS
Sixty women with PCOS and 19 women with normal menstruation.


METHODS
Administration of human corticotropin-releasing hormone (hCRH), dexamethasone suppression testing, and stimulation of ovulation with clomiphene citrate.


METHODS
Plasma cortisol and ACTH levels, plasma androstenedione and DHEAS levels, and ovulation rates.


RESULTS
In women with PCOS, plasma ACTH and cortisol levels were significantly higher and the plasma ACTH level after the administration of hCRH was higher than in controls. Based on the response to hCRH, patients with PCOS could be classified into three categories: those with a normal response to hCRH (group 1), those with an exaggerated response of ACTH to hCRH (group 2), and those with a high basal level of cortisol and a poor response to hCRH (group 3). In groups 2 and 3, DHEAS levels were significantly higher, suppression of androstenedione by dexamethasone was significantly greater, and ovulation rates with clomiphene citrate were significantly lower than in group 1.


CONCLUSIONS
This classification provides insight into the underlying cause of PCOS and thus is useful in selecting appropriate treatment.
Kondoh
Y
Y
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Uemura
T
T
Ishikawa
M
M
Yokoi
N
N
Hirahara
F
F
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000728:Androgens / Q000097:blood; D002996:Clomiphene / Q000008:administration & dosage; D015331:Cohort Studies; D003346:Corticotropin-Releasing Hormone; D003907:Dexamethasone; D005260:Female; D006065:Gonadotropins, Pituitary / Q000097:blood; D006628:Hirsutism / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010060:Ovulation / Q000187:drug effects; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000145:classification* / Q000150:complications
D000728:Androgens; D006065:Gonadotropins, Pituitary; D002996:Clomiphene; D019326:17-alpha-Hydroxyprogesterone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone