Ovarian-adrenal cross-talk in polycystic ovary syndrome: evidence from wedge resection.
OBJECTIVE
To determine whether the ovary influences adrenal androgen secretion in women with polycystic ovary syndrome (PCOS).


METHODS
Six PCOS-affected patients with clomiphene resistance and gonadotrophin hyperresponsivity, and six controls with regular ovulatory cycles, matched for age and body mass index.


METHODS
Bilateral ovarian wedge resection was performed to induce ovulation surgically for these refractory women with PCOS. The adrenal androgen secretions were evaluated in PCOS patients before and again 6 months after this surgery, and in the controls, using an ACTH stimulation test (0.25mg synthetic ACTH(1-24)).


RESULTS
Biochemically, basal levels and the maximum net increases (Delta) of 17-hydroxyprogesterone (17-OHP) and androstenedione, Delta17-OHP/Delta progesterone and Delta androstenedione/Delta17-OHP ratios in response to exogenous ACTH were significantly higher in PCOS patients before operation than those of controls. This purely ovarian surgery in women with PCOS was found to significantly reduce their basal androstenedione, testosterone and LH levels, insulin/glucose ratio, and post-corticotrophic Delta17-OHP, Delta androstenedione, Delta17-OHP/Delta progesterone and Delta androstenedione/Delta17-OHP, without obvious changes in FSH, oestradiol, sex hormone-binding globulin, Delta dehydroepiandrosterone, Delta dehydroepiandrosterone sulphate, Delta aldosterone and Delta cortisol values.


CONCLUSIONS
Ovarian hyperandrogenicity from polycystic ovary may contribute to the enhanced adrenal P450c17alpha activity and subsequent Delta(4) androgen reserve revealed by the pharmacological corticotrophin stimulation in our special PCOS cases.
Wu
X K
XK
Department of Obsterics and Gynaecology, Jinling Hospital of Nanjing University, Nanjing 210002, China. xiaoke.wu@utu.fi
Zhou
S Y
SY
Sallinen
K
K
Pöllänen
P
P
Erkkola
R
R
D000311:Adrenal Glands / Q000378:metabolism / Q000502:physiology*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000728:Androgens / Q000378:metabolism*; D003366:Cosyntropin; D004351:Drug Resistance; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D010053:Ovary / Q000502:physiology* / Q000601:surgery; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery
D000728:Androgens; D012739:Gonadal Steroid Hormones; D003366:Cosyntropin; D000324:Adrenocorticotropic Hormone