CLINICAL FINDINGS AND HORMONAL RESPONSES IN PATIENTS WITH POLYCYSTIC OVARIAN DISEASE WITH NORMAL VERSUS ELEVATED LH LEVELS

Abstract

The clinical features, ovarian pathology and hormonal responses to dexamethasone (Dex) Dex + ethinyl estradiol (EE), and Dex + hCG (human chorionic gonadotropin) were compared in 5 women with polycystic ovarian disease (PCOD) who have normal 24-h urinary luteinizing hormone (LH) levels to 5 who had elevated urinary LH levels. No differences were noted in the clinical features. There was no correlation between ovary size and LH levels. Three in the normal-LH group had hyperthecosis. Plasma androstenedione (A) was more frequently elevated in the high-LH group. Dex + EE markedly increased LH secretion in the high-LH group, suggesting increased responsiveness of the positive feedback control mechanism of LH secretion in the high-LH group. There was a greater response of androstenedione (A), testosterone (T) and 17-ketosteroids (KS) to Dex + hCG in the normal-LH group. Those with high-LH levels did not exhibit a significant increase in A, T and 17-KS with hCG. The limitations and usefulness of the Dex + hCG test are discussed. The hypothesis is advanced that the increased LH secretion in the high-LH group is due at least in part to positive feedback resulting from the increased A levels. The amount of 17.beta.-oxidoreductase activity in the ovary may influence LH secretion in PCOD.