Asymptomatic volunteers with a polycystic ovary are a functionally distinct but heterogeneous population.
OBJECTIVE
Our objective was to determine the ovarian function of asymptomatic volunteers with a polycystic ovary (V-PCO).


METHODS
Non-hirsute eumenorrheic V-PCO (n = 32) and volunteers with ultrasonographically normal ovaries (V-NO) (n = 21) were compared with one another and with polycystic ovary syndrome (PCOS) patients who met National Institute of Health criteria (n = 90). DESIGN/SETTING/INTERVENTIONS: GnRH agonist (GnRHag), ACTH, and oral glucose tolerance tests were prospectively performed in a General Clinical Research Center.


RESULTS
The distribution of 17-hydroxyprogesterone (17OHP) responses to GnRHag of V-PCO formed a distinct population intermediate between that of V-NO, the reference population, and PCOS. Nevertheless, the V-PCO population was heterogeneous. There were 53% (seventeen of 32) that were functionally normal, with 17OHP responses and free testosterone levels like V-NO. A total of 25% (eight of 32) had an elevated free testosterone, thus meeting Rotterdam criteria for PCOS; one third of these had 17OHP hyperresponsiveness to GnRHag testing. The remaining 22% (seven of 32) had 17OHP hyperresponsiveness to GnRHag, but normal free testosterone. Of PCOS, 69% had elevated 17OHP hyperresponsiveness to GnRHag. Ovarian volume correlated significantly with 17OHP responses only in PCOS, accounting for just 10% of the variance.


CONCLUSIONS
Many asymptomatic volunteers have a PCO. They are a distinct, but heterogeneous, population with respect to ovarian function, ranging from normal (53%) to occult PCOS by Rotterdam criteria (25%). Nearly one quarter (22%) had the typical PCOS type of ovarian dysfunction without hyperandrogenemia, termed a "dysregulated PCO"; they or their offspring may be at risk for PCOS. Ovarian ultrasonographic characteristics must be considered when establishing norms for ovarian function.
Mortensen
Monica
M
Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Ehrmann
David A
DA
Littlejohn
Elizabeth
E
Rosenfield
Robert L
RL
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000858:Anovulation / Q000209:etiology; D015992:Body Mass Index; D002675:Child, Preschool; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D017588:Hyperandrogenism / Q000209:etiology; D007986:Luteinizing Hormone / Q000097:blood; D010053:Ovary / Q000000981:diagnostic imaging / Q000503:physiopathology; D010388:Pelvis / Q000000981:diagnostic imaging; D010641:Phenotype; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography; D055815:Young Adult
D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone; D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone