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Adrenal volumes reduced, steroid hormone secretion increased after dexamethasone in PCOS
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In some women with polycystic ovary syndrome, smaller adrenal volumes and higher steroid hormone secretion after dexamethasone therapy were detected, according to study results.
“A group of women with PCOS produced more adrenal hormone compared to healthy women, and these women also had some characteristics of micronodular adrenal hyperplasia in their adrenals,” Evgenia Gourgari, MD, assistant professor, division of pediatric endocrinology, MedStar Georgetown University Hospital in Washington, D.C., told Endocrine Today. “Our findings suggest that a problem in the adrenal glands may be the underlying cause of PCOS in a subgroup of women with this syndrome.”
Evgenia Gourgari
Gourgari and colleagues evaluated 38 women with PCOS and 20 healthy controls aged 16 to 29 years to assess the pituitary adrenal axis with an oral low- and high-dose dexamethasone-suppression test. The main outcomes included urinary free cortisol and 17-hydroxy steroids before and after low- and high-dose dexamethasone and adrenal volume assessed by CT. Urine collection was done on day 1 (baseline), oral low-dose dexamethasone 0.5 mg was given every 6 hours on days 2 and 3, oral dexamethasone 2 mg was given every 6 hours on days 4 and 5 and the final urine collection was done on day 6.
Urinary free cortisol levels were similar between the groups at baseline and at the end of the low-dose dexamethasone treatment. On day 6, urinary free cortisol was lower in controls (1.5 µg/m2/day) compared with the PCOS group (2 µg/m2/day; P = .038), suggesting that urinary free cortisol showed less suppression against high-dose dexamethasone in the PCOS group compared with controls.
Adrenal volumes were negatively correlated with 17-hydroxy steroids (P = .009) and urinary free cortisol (P < .001) on day 5. After high-dose dexamethasone, a smaller total adrenal volume was found among the PCOS group about the 75th percentile for urinary free cortisol and/or 17-hydroxy steroids (n = 15) compared with the rest of the PCOS group (n = 22; P = .003), but there were no differences for insulin resistance of hyperandrogenism.
“A subset of women with PCOS can have a problem with their adrenal glands that maybe they were born with,” Gourgari told Endocrine Today. “It is a new idea in the field and needs validation, but it may lead to elucidating at least part of the etiology of this complex and multifactorial condition that might lead to new ways of treatment in the future. Further research in a larger group of women with PCOS is needed to validate our findings. More research is needed to examine whether treatment that improves adrenal hormones can also improve symptoms of PCOS.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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