Plasma Testosterone and Urinary 17-Ketosteroids in Women with Hirsutism and Polycystic Ovaries

Plasma testosterone and urinary 17-ketosteroids were measured in women with idiopathic hirsutism (IH) or polycystic ovaries (PCO). Base line plasma testosterone values were elevated more often than were urinary 17-ketosteroids (17-KS). In an attempt to define the sources of androgen, the patients, and a group of normal volunteers, were treated with ACTH, dexamethasone and with dexamethasone plus HCG. Plasma testosterone in normal women showed little if any change during treatment with these hormones. The plasma testosterone response to administration of ACTH in patients was extremely variable, increasing in some and decreasing in others. IH patients usually had a decrease in testosterone levels while they received dexamethasone; those with PCO had less consistent changes. Stimulation with HCG caused appreciable increases in testosterone in all groups. Plasma testosterone fell after ovarian wedge resection in 4 women. The response of urinary 17-KS to hormone administration was often of diagnostic value and aided in separation into groups in which the excess androgen appeared to originate from either adrenal or ovarian sources. Considerable overlap between these groups was evident. Although adrenal or ovarian malfunction could be incriminated with confidence in some patients, many patients seemed to have a degree of contribution from both glands. There was a positive correlation between the increments in plasma testosterone and urinary 17-KS due to the administration of HCG in the PCO group (p<.02>.01). This procedure may be helpful in deciding whether an ovarian component is present in patients with so-called idiopathic hirsutism.