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Detection of functional ovarian hyperandrogenism in women with androgen excess.
N Engl J Med. 1992 Jul 16; 327(3):157-62.NEJM

Abstract

BACKGROUND

Distinguishing between ovarian and adrenal causes of androgen excess may be difficult. We have found that women with the polycystic ovary syndrome have supranormal plasma 17-hydroxyprogesterone responses to the gonadotropin-releasing hormone agonist nafarelin. We determined the usefulness of testing with nafarelin to distinguish ovarian causes of hyperandrogenism in women.

METHODS

We studied 40 consecutive women with hyperandrogenism who had oligomenorrhea, hirsutism, or acne. All 40 underwent testing with nafarelin, dexamethasone, and corticotropin with measurement of circulating concentrations of gonadotropins and steroid hormones, and 19 underwent ovarian ultrasonography.

RESULTS

The plasma 17-hydroxyprogesterone response to nafarelin was supranormal in 23 of the 40 women (58 percent), and the plasma androgen response to corticotropin was elevated in 23; 13 women had both abnormalities. Only one woman had conclusive evidence of a steroidogenic block; she had nonclassic adrenal 21-hydroxylase deficiency. Of the 23 women with abnormal responses to nafarelin, only 11 (48 percent) had elevated base-line serum luteinizing hormone concentrations. Of the 13 women with abnormal responses to nafarelin who underwent ultrasonography, 7 (54 percent) had polycystic ovaries. Peak plasma 17-hydroxyprogesterone concentrations after nafarelin administration correlated closely with plasma free testosterone concentrations after dexamethasone administration (r = 0.75, P less than 0.001).

CONCLUSIONS

Approximately half of women with oligomenorrhea, hirsutism, or acne have an abnormal response to the gonadotropin-releasing hormone agonist nafarelin, suggesting an ovarian cause of their androgen excess.

Authors+Show Affiliations

Department of Medicine, University of Chicago, Pritzker School of Medicine, IL 60637.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

1319000

Citation

Ehrmann, D A., et al. "Detection of Functional Ovarian Hyperandrogenism in Women With Androgen Excess." The New England Journal of Medicine, vol. 327, no. 3, 1992, pp. 157-62.
Ehrmann DA, Rosenfield RL, Barnes RB, et al. Detection of functional ovarian hyperandrogenism in women with androgen excess. N Engl J Med. 1992;327(3):157-62.
Ehrmann, D. A., Rosenfield, R. L., Barnes, R. B., Brigell, D. F., & Sheikh, Z. (1992). Detection of functional ovarian hyperandrogenism in women with androgen excess. The New England Journal of Medicine, 327(3), 157-62.
Ehrmann DA, et al. Detection of Functional Ovarian Hyperandrogenism in Women With Androgen Excess. N Engl J Med. 1992 Jul 16;327(3):157-62. PubMed PMID: 1319000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of functional ovarian hyperandrogenism in women with androgen excess. AU - Ehrmann,D A, AU - Rosenfield,R L, AU - Barnes,R B, AU - Brigell,D F, AU - Sheikh,Z, PY - 1992/7/16/pubmed PY - 1992/7/16/medline PY - 1992/7/16/entrez SP - 157 EP - 62 JF - The New England journal of medicine JO - N Engl J Med VL - 327 IS - 3 N2 - BACKGROUND: Distinguishing between ovarian and adrenal causes of androgen excess may be difficult. We have found that women with the polycystic ovary syndrome have supranormal plasma 17-hydroxyprogesterone responses to the gonadotropin-releasing hormone agonist nafarelin. We determined the usefulness of testing with nafarelin to distinguish ovarian causes of hyperandrogenism in women. METHODS: We studied 40 consecutive women with hyperandrogenism who had oligomenorrhea, hirsutism, or acne. All 40 underwent testing with nafarelin, dexamethasone, and corticotropin with measurement of circulating concentrations of gonadotropins and steroid hormones, and 19 underwent ovarian ultrasonography. RESULTS: The plasma 17-hydroxyprogesterone response to nafarelin was supranormal in 23 of the 40 women (58 percent), and the plasma androgen response to corticotropin was elevated in 23; 13 women had both abnormalities. Only one woman had conclusive evidence of a steroidogenic block; she had nonclassic adrenal 21-hydroxylase deficiency. Of the 23 women with abnormal responses to nafarelin, only 11 (48 percent) had elevated base-line serum luteinizing hormone concentrations. Of the 13 women with abnormal responses to nafarelin who underwent ultrasonography, 7 (54 percent) had polycystic ovaries. Peak plasma 17-hydroxyprogesterone concentrations after nafarelin administration correlated closely with plasma free testosterone concentrations after dexamethasone administration (r = 0.75, P less than 0.001). CONCLUSIONS: Approximately half of women with oligomenorrhea, hirsutism, or acne have an abnormal response to the gonadotropin-releasing hormone agonist nafarelin, suggesting an ovarian cause of their androgen excess. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1319000/Detection_of_functional_ovarian_hyperandrogenism_in_women_with_androgen_excess_ L2 - https://www.nejm.org/doi/10.1056/NEJM199207163270304?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -