Adrenal androgen excess and defective 11 beta-hydroxylation in women with idiopathic hirsutism

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Abstract
The simultaneous responses of 4 serum androgens (testosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate) and 5 other steroids (deoxycorticosterone, corticosterone, 11-deoxycortisol, cortisol, and 17.alpha.-hydroxyprogesterone) to the infusion of small amounts of cosyntropin in 8 patients with idiopathic hirsutism and in 6 normal women were studied. Serum testosterone and androstenedione concentrations were significantly higher in hirsute women after graded cosyntropin infusions than in controls, as were concentrations of plasma deoxycorticosterone and 11-deoxycortisol. Analysis of the substrate/product ratios 11-deoxycortisol/cortisol and deoxycorticosterone/corticosterone revealed defective 11.beta.-hydroxylation in women with hirsutism. The presence of increased circulating androgen levels in response to physiologic amounts of ACTH thus appears to be a common response in women with idiopathic hirsutism, and, together with impaired adrenal 11.beta.-hydroxylation, points to an adrenal defect as an important component of this disorder.