Ovarian-adrenal cross-talk in polycystic ovary syndrome: Evidence from wedge resection

Abstract

Objective: To determine whether the ovary influences adrenal androgen secretion in women with polycystic ovary syndrome (PCOS). Design: Six PCOS-affected patients with clomiphene resistance and gonadotrophin hyperresponsivity, and six controls with regular ovulatory cycles, matched for age and body mass index. Methods: Bilateral ovarian wedge resection was performed to induce ovulation surgically for these refractory women with PCOS. The adrenal androgen secretions were evaluated in PCOS patients before and again 6 months after this surgery, and in the controls, using an ACTH stimulation test (0.25 mg synthetic ACTH(1-24)). Results: Biochemically, basal levels and the maximum net increases (Δ) of 17-hydroxyprogesterone (17-OHP) and androstenedione, Δ17-OHP/Δprogesterone and Δandrostenedione/Δ17-OHP ratios in response to exogenous ACTH were significantly higher in PCOS patients before operation than those of controls. This purely ovarian surgery in women with PCOS was found to significantly reduce their basal androstenedione, testosterone and LH levels, insulin/glucose ratio, and post-corticotrophic Δ17-OHP, Δandrostenedione, Δ17-OHP/Δprogesterone and Δandrostenedione/Δ17-OHP, without obvious changes in FSH, oestradiol, sex hormone-binding globulin, Δdehydroepiandrosterone, Δdehydroepiandrosterone sulphate, Δaldosterone and Δcortisol values. Conclusions: Ovarian hyperandrogenicity from polycystic ovary may contribute to the enhanced adrenal P450c17α activity and subsequent Δ4 androgen reserve revealed by the pharmacological corticotrophin stimulation in our special PCOS cases.