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Effect of Dexamethasone on Serum Cortisol and Androgen Levels in Hirsute Patients

From the Department of Obstetrics and Gynecology. Division of Reproductive Biology. UCLA School of Medicine. Harbor General Hospital Campus. Torrance. California

Abstract

The scrum levels uf the following steroids were measured in 59 hirsute patients before (control) and after (post-dexamclhasonc) administration of dexaincthasonc(Dcx) for 7 days: cortisol (F), dehydrocpiandrosterone (DI1EA), its sulfate (DIIKA-S). androstenedione (A), testosterone (T), and Sw-dihydrotestosterone (DHT). Assuming that Dcx-suppressibility implied adrenal origin, the source of excess androgens was also evaluated. All patients showed elevated levels of at least one androgen. Eleven patients had an elevated level of only one androgen: 4 had elevated DHEA-S; 4 had elevated T; .1 had elevated DHT. No patient had an elevated 1)11EA or A without an elevation of the other androgens. The control levels of DHEA-S were above normal in 45 patients; the DHT levels were elevated in 43 patients; 31 patients had elevated T levels; and 25 patients elevated A; and 24 patients, DIIKA levels. In 32 patients with adequate suppression of adrenal androgens after 7 days or Dex administration, the source of excess androgenscould be evaluated. Of 13 patients with elevated A levels, the excess A production was of adrenal origin in 6 cases, of ovarian origin in 5 cases, and of mixed origin in 2 cases. Of 15 patients with elevated T levels, the excess T production was of adrenal origin in 3 cases, of ovarian origin in 10 cases, and of mixed origin in the remaining 2 cases. Of 25 patients with elevated DHT levels, the excess DHT production was of adrenal origin in 16 patients, of ovarian origin in 5 patients, and of mixed origin in 4 patients. Of the 32 patients with an adequate Dex suppression test, 14 showed evidence of adrenal hyperandrogenism. 5 had ovarian hyperandrogenism, and mixed hypcrandrogenism was present in the remaining 13 patients. There was an adrenal source of hyperandrogenism in 27 of 32 patients (14 pure adrenal and 13 mixed adrenal-ovarian), which represents 85% of the 32 patients.