title: Evaluation of the pituitary-adrenal axis in hyperandrogenic women with polycystic ovary syndrome.
abstract: OBJECTIVE
  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 microg) ACTH test and to compare it with the standard ACTH (250 microg) test in hyperandrogenic women with PCOS.
  
  
  METHODS
  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 microg ACTH (SDT) and after 1 microg 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 microg) but not by a physiological dose (1 microg).
authors.affiliation: Endocrine Institute, Haemek Medical Center, Afula, Israel. luboshitzky_r@clalit.org.il
authors.forename: Rafael
authors.initials: R
authors.lastname: Luboshitzky
authors.forename: Abraham
authors.initials: A
authors.lastname: Ishai
authors.forename: Zila
authors.initials: Z
authors.lastname: Shen-Or
authors.forename: Paula
authors.initials: P
authors.lastname: Herer
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D005260:Female; D006628:Hirsutism / Q000097:blood / Q000503:physiopathology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D017588:Hyperandrogenism / Q000235:genetics / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011085:Polycystic Ovary Syndrome / Q000235:genetics / Q000503:physiopathology*; D013254:Steroid 17-alpha-Hydroxylase / Q000235:genetics / Q000378:metabolism; D013268:Stimulation, Chemical
chemical_list: D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D013254:Steroid 17-alpha-Hydroxylase; D006854:Hydrocortisone