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The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia.
Fertil Steril. 2010 Jul; 94(2):684-9.FS

Abstract

OBJECTIVE

To test the hypothesis that women with polycystic ovary syndrome (PCOS) are distinguishable from those with 21-hydroxylase-deficient nonclassic adrenal hyperplasia on the basis of having polycystic ovaries and metabolic dysfunction.

DESIGN

Prospective observational.

SETTING

Tertiary care center.

PATIENT(S)

Fifty-two lean and 54 obese women with PCOS according to the 1990 National Institutes of Health criteria, 23 women with nonclassic adrenal hyperplasia, and 27 controls.

INTERVENTION(S)

History and physical examination, blood sampling, ovarian sonography, oral glucose tolerance, and acute adrenocorticotropin stimulation testing.

MAIN OUTCOME MEASURE(S)

The frequency of clinical, biochemical, and metabolic features.

RESULT(S)

Women with PCOS had a higher frequency of oligomenorrhea or amenorrhea than those with nonclassic adrenal hyperplasia. Mean androstenedione and DHEAS levels were highest in nonclassic adrenal hyperplasia. The degree of metabolic dysfunction was greatest in obese women with PCOS; women with nonclassic adrenal hyperplasia and lean women with PCOS did not differ in degree of metabolic dysfunction. Women with nonclassic adrenal hyperplasia had a lower prevalence of polycystic ovaries than those with PCOS. The proportion of patients with an LH/FSH ratio >2 was greater in women with PCOS, compared with those with nonclassic adrenal hyperplasia. Basal 17-hydroxyprogesterone levels >2 ng/mL were found in 87%, 25%, 20%, and 7% of women with nonclassic adrenal hyperplasia, lean women with PCOS, obese women with PCOS, and controls, respectively.

CONCLUSION(S)

Nonclassic adrenal hyperplasia should be excluded in all women presenting with hirsutism, with use of a basal follicular phase 17-hydroxyprogesterone level, regardless of the presence of polycystic ovaries or metabolic dysfunction; however, women with nonclassic adrenal hyperplasia have a higher prevalence of normal ovulation and lower likelihood of having an LH/FSH ratio >2 or polycystic ovaries.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19726039

Citation

Pall, Marita, et al. "The Phenotype of Hirsute Women: a Comparison of Polycystic Ovary Syndrome and 21-hydroxylase-deficient Nonclassic Adrenal Hyperplasia." Fertility and Sterility, vol. 94, no. 2, 2010, pp. 684-9.
Pall M, Azziz R, Beires J, et al. The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia. Fertil Steril. 2010;94(2):684-9.
Pall, M., Azziz, R., Beires, J., & Pignatelli, D. (2010). The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia. Fertility and Sterility, 94(2), 684-9. https://doi.org/10.1016/j.fertnstert.2009.06.025
Pall M, et al. The Phenotype of Hirsute Women: a Comparison of Polycystic Ovary Syndrome and 21-hydroxylase-deficient Nonclassic Adrenal Hyperplasia. Fertil Steril. 2010;94(2):684-9. PubMed PMID: 19726039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The phenotype of hirsute women: a comparison of polycystic ovary syndrome and 21-hydroxylase-deficient nonclassic adrenal hyperplasia. AU - Pall,Marita, AU - Azziz,Ricardo, AU - Beires,Jorge, AU - Pignatelli,Duarte, Y1 - 2009/09/01/ PY - 2008/10/15/received PY - 2009/06/09/revised PY - 2009/06/09/accepted PY - 2009/9/4/entrez PY - 2009/9/4/pubmed PY - 2010/7/24/medline SP - 684 EP - 9 JF - Fertility and sterility JO - Fertil Steril VL - 94 IS - 2 N2 - OBJECTIVE: To test the hypothesis that women with polycystic ovary syndrome (PCOS) are distinguishable from those with 21-hydroxylase-deficient nonclassic adrenal hyperplasia on the basis of having polycystic ovaries and metabolic dysfunction. DESIGN: Prospective observational. SETTING: Tertiary care center. PATIENT(S): Fifty-two lean and 54 obese women with PCOS according to the 1990 National Institutes of Health criteria, 23 women with nonclassic adrenal hyperplasia, and 27 controls. INTERVENTION(S): History and physical examination, blood sampling, ovarian sonography, oral glucose tolerance, and acute adrenocorticotropin stimulation testing. MAIN OUTCOME MEASURE(S): The frequency of clinical, biochemical, and metabolic features. RESULT(S): Women with PCOS had a higher frequency of oligomenorrhea or amenorrhea than those with nonclassic adrenal hyperplasia. Mean androstenedione and DHEAS levels were highest in nonclassic adrenal hyperplasia. The degree of metabolic dysfunction was greatest in obese women with PCOS; women with nonclassic adrenal hyperplasia and lean women with PCOS did not differ in degree of metabolic dysfunction. Women with nonclassic adrenal hyperplasia had a lower prevalence of polycystic ovaries than those with PCOS. The proportion of patients with an LH/FSH ratio >2 was greater in women with PCOS, compared with those with nonclassic adrenal hyperplasia. Basal 17-hydroxyprogesterone levels >2 ng/mL were found in 87%, 25%, 20%, and 7% of women with nonclassic adrenal hyperplasia, lean women with PCOS, obese women with PCOS, and controls, respectively. CONCLUSION(S): Nonclassic adrenal hyperplasia should be excluded in all women presenting with hirsutism, with use of a basal follicular phase 17-hydroxyprogesterone level, regardless of the presence of polycystic ovaries or metabolic dysfunction; however, women with nonclassic adrenal hyperplasia have a higher prevalence of normal ovulation and lower likelihood of having an LH/FSH ratio >2 or polycystic ovaries. SN - 1556-5653 UR - https://www.unboundmedicine.com/medline/citation/19726039/The_phenotype_of_hirsute_women:_a_comparison_of_polycystic_ovary_syndrome_and_21_hydroxylase_deficient_nonclassic_adrenal_hyperplasia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015-0282(09)01327-2 DB - PRIME DP - Unbound Medicine ER -