Plasma Androgens in Patients with the Polycystic Ovary Syndrome1

Abstract

Eight patients with the polycystic ovary syndrome (PCO) and hirsutism were studied. Diagnosis was made on the basis of the clinical picture and culdoscopic observation of the ovaries and/or ovarian biopsy. The mean plasma testosterone concentration was 210 mμg and plasma androstenedione 380 mμg/100 ml by double isotope derivative methods using ³⁵S thiosemicarbazide. These values are elevated many times over normal values obtained with these methods. One case, despite histological evidence of polycystic ovaries, had normal plasma androgen values. The metabolic clearance rate (mean 2060 liters/day) and conversion ratio (mean 18.5%) of androstenedione to testosterone in 6 patients studied were normal. This suggests that the over-all metabolism of the major androgen precursor and its peripheral conversion to plasma testosterone is normal. The c 1 ulated mean blood production rate of androstenedione in these patients was 7.8 mg/day. Only ⅓ of plasma testosterone in the PCO syndrome is derived from peripheral conversion of androstenedione, unlike the conclusion reached for plasma testosterone in the normal female, and in patients with congenital adrenal hyperplasia. A major fraction of blood testosterone in PCO appears to result from direct glandular secretion. Monthlong suppression with a synthetic glucocorticoid lowered both plasma androgens to normal in the 5 patients studied. This finding, taken with previous observations, gives further support to the concept that the PCO syndrome involves a general disorder of steroid producing tissue.