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ACTH stimulation tests and plasma dehydroepiandrosterone sulfate levels in women with hirsutism.
N Engl J Med. 1990 Sep 27; 323(13):849-54.NEJM

Abstract

BACKGROUND

Hirsutism in women is a clinical manifestation of excessive production of androgens. The source of the excess androgen may be either the ovaries or the adrenal glands, and distinguishing between these sources may be difficult.

METHODS

To determine whether measurements of plasma dehydroepiandrosterone (DHEA) sulfate and ACTH stimulation tests, both widely used in the evaluation of hirsutism in women, provide useful information, we performed both tests in 22 normal women and 31 female patients with hirsutism. The hormones measured in plasma during the ACTH stimulation tests were progesterone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, DHEA, androstenedione, 11-deoxycortisol, and cortisol.

RESULTS

The women with hirsutism were divided into four groups based on their individual responses to ACTH stimulation: patients with a possible 3 beta-hydroxy-delta 5-steroid dehydrogenase deficiency, those with a possible 21-hydroxylase deficiency, those with a possible 11 beta-hydroxylase deficiency, and those with no apparent defect in steroidogenesis. The results in 19 patients (61 percent) suggested subtle defects in adrenal steroidogenesis. There was no significant correlation between the basal plasma DHEA sulfate levels and the hormonal response to ACTH, nor were the basal levels of hormones predictive of the levels after ACTH stimulation. Eleven patients had significantly elevated basal levels of plasma DHEA sulfate; only 5 of these 11 had responses to ACTH suggestive of compromised steroidogenesis. Thirteen patients who had responses suggestive of defective steroidogenesis had DHEA sulfate levels within the normal range.

CONCLUSIONS

A substantial proportion of women with hirsutism have mild defects in adrenal steroidogenesis, revealed by an ACTH stimulation test, that are indicative of late-onset (nonclassic) congenital adrenal hyperplasia. Measurements of basal steroid levels are not helpful in differentiating among the causes of increased androgen production in such patients and may be misleading.

Authors+Show Affiliations

Department of Pediatrics, University of Pittsburgh School of Medicine, PA.No 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

2168515

Citation

Siegel, S F., et al. "ACTH Stimulation Tests and Plasma Dehydroepiandrosterone Sulfate Levels in Women With Hirsutism." The New England Journal of Medicine, vol. 323, no. 13, 1990, pp. 849-54.
Siegel SF, Finegold DN, Lanes R, et al. ACTH stimulation tests and plasma dehydroepiandrosterone sulfate levels in women with hirsutism. N Engl J Med. 1990;323(13):849-54.
Siegel, S. F., Finegold, D. N., Lanes, R., & Lee, P. A. (1990). ACTH stimulation tests and plasma dehydroepiandrosterone sulfate levels in women with hirsutism. The New England Journal of Medicine, 323(13), 849-54.
Siegel SF, et al. ACTH Stimulation Tests and Plasma Dehydroepiandrosterone Sulfate Levels in Women With Hirsutism. N Engl J Med. 1990 Sep 27;323(13):849-54. PubMed PMID: 2168515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - ACTH stimulation tests and plasma dehydroepiandrosterone sulfate levels in women with hirsutism. AU - Siegel,S F, AU - Finegold,D N, AU - Lanes,R, AU - Lee,P A, PY - 1990/9/27/pubmed PY - 1990/9/27/medline PY - 1990/9/27/entrez SP - 849 EP - 54 JF - The New England journal of medicine JO - N Engl J Med VL - 323 IS - 13 N2 - BACKGROUND: Hirsutism in women is a clinical manifestation of excessive production of androgens. The source of the excess androgen may be either the ovaries or the adrenal glands, and distinguishing between these sources may be difficult. METHODS: To determine whether measurements of plasma dehydroepiandrosterone (DHEA) sulfate and ACTH stimulation tests, both widely used in the evaluation of hirsutism in women, provide useful information, we performed both tests in 22 normal women and 31 female patients with hirsutism. The hormones measured in plasma during the ACTH stimulation tests were progesterone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, DHEA, androstenedione, 11-deoxycortisol, and cortisol. RESULTS: The women with hirsutism were divided into four groups based on their individual responses to ACTH stimulation: patients with a possible 3 beta-hydroxy-delta 5-steroid dehydrogenase deficiency, those with a possible 21-hydroxylase deficiency, those with a possible 11 beta-hydroxylase deficiency, and those with no apparent defect in steroidogenesis. The results in 19 patients (61 percent) suggested subtle defects in adrenal steroidogenesis. There was no significant correlation between the basal plasma DHEA sulfate levels and the hormonal response to ACTH, nor were the basal levels of hormones predictive of the levels after ACTH stimulation. Eleven patients had significantly elevated basal levels of plasma DHEA sulfate; only 5 of these 11 had responses to ACTH suggestive of compromised steroidogenesis. Thirteen patients who had responses suggestive of defective steroidogenesis had DHEA sulfate levels within the normal range. CONCLUSIONS: A substantial proportion of women with hirsutism have mild defects in adrenal steroidogenesis, revealed by an ACTH stimulation test, that are indicative of late-onset (nonclassic) congenital adrenal hyperplasia. Measurements of basal steroid levels are not helpful in differentiating among the causes of increased androgen production in such patients and may be misleading. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/2168515/ACTH_stimulation_tests_and_plasma_dehydroepiandrosterone_sulfate_levels_in_women_with_hirsutism_ L2 - https://www.nejm.org/doi/10.1056/NEJM199009273231301?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -