Human Reproduction, Vol. 14, No. 2, 307-311,
February 1999
© 1999 European Society of Human Reproduction and Embryology
The contributions of oestrogen and growth factors to increased adrenal androgen secretion in polycystic ovary syndrome
1 Department of Obstetrics & Gynecology, College of Physicians & Surgeons of Columbia University, 630 West 168th Street, New York, NY, 2 Department of Obstetrics and Gynecology, State University of New York at Buffalo School of Medicine & Biomedical Sciences, Buffalo, NY and 3 Department of Obstetrics & Gynecology, University of Southern California School of Medicine, Los Angeles, CA, USA
Adrenal hyperandrogenism is prevalent in many women with polycystic ovary syndrome (PCOS), although the expression of this enhanced secretion may be heterogeneous. Since no single factor acts in isolation, this study was performed to assess the influence of oestradiol (total and unbound), insulin, insulin-like growth factor (IGF)-I, IGF-II and the binding proteins IGFBP-I, and IGFBP-3, on basal and adrenocorticotrophic hormone (ACTH) stimulated adrenal androgen secretion in 25 women with PCOS and 10 matched ovulatory controls. Women with PCOS exhibited elevations of all androgens as well as unbound oestradiol, insulin and non-IGFBP-1 bound IGF-I. Positive correlations were noted between oestrogen and basal and ACTH stimulated 
5 adrenal androgens. Serum IGF-I was only correlated with basal dehydroepiandrosterone sulphate (DHEA-S), while insulin exhibited a strong correlation with the 4 pathway and androstenedione formation in particular. This correlation was also confirmed by dividing the PCOS group into those women with and without hyperinsulinaemia. The activity of 17,20 lyase favouring androstenedione was increased in the hyperinsulinaemic women. By multivariate analyses, body mass index did not influence these findings. Although there are inherent difficulties in making major conclusions based on correlative analyses, it is suggested that oestrogen may have a greater influence on enhancing 5 adrenal androgen secretion, and insulin a greater effect on the 4 pathway. In turn, the relative importance of these influences may contribute to the heterogeneous nature of adrenal hyperandrogenism in PCOS.
Key words: adrenal androgens/IGF-I/insulin/oestrogen/PCOS
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