PLASMA ANDROGENS IN WOMEN

Abstract

Plasma levels of conjugated DHEA, conjugated androsterone (modified method of Migeon & Plager) and testosterone (method of Finkelstein et al.) were determined in a group of 20 patients with polycystic ovaries and hirsutism or virilism, before and after intravenous HCG stimulation and ACTH-suppression with dexamethasone. Mean values for testosterone, conjugated DHEA and androsterone were.34 ±.24 μg/100 ml, 50.9 ± 28.3 μg/100 ml and 31.4 ± 19.4 μg/100 ml respectively, all significantly higher than levels found in normal women. In all, but 3 cases, testosterone values were above the 2-sigma range of normal women in contrast to the frequent overlapping observed for conjugated DHEA and androsterone. HCG stimulation led to a significant rise in the mean value of testosterone (.61 ±.22 μg/100 ml) but little change was seen in those of the conjugates. While dexamethasone caused a marked decrease of testosterone in only 2 patients, it led to a pronounced fall in DHEA values and a lesser but significant drop in androsterone concentrations in most patients. In patients with a unilateral polycystic or with bilateral polycystic ovaries but without hirsutism or virilism similar values were noted. Two patients with arrhenoblastomas, 4 patients with adrenal disorders and 13 patients with hirsutism of unknown origin were studied and their findings presented. All patients with hirsutism or virilism had a higher mean value of testosterone than did normal women. The testosterone levels did not parallel the severity, although a correlation did seem to exist in the mildly and moderately hirsute patients. Plasma androgen determinations in general and plasma testosterone studies, in particular, while helpful in elucidating the clinical manifestations of masculinization do not allow the investigator to differentiate an adrenal from an ovarian source. Adjunctive studies, utilizing HCG and dexamethasone, are helpful, but not conclusive.