Int J Gynaecol Obstet 17:78-82, 1979
The Significance of Adrenal and Ovarian Catheterization in Patients with Polycystic Ovary Syndrome Vassilios A. Tzingounis, M. Feridun Aksu, Puthugramam K. Natrajan and Robert B. Greenblatt Medical College of Georgia, Augusta, Georgia, USA
ABSTRACT Tzingounis VA, Aksu MF, Natrajan PK, Greenblatt RB (Medical College of Georgia, Augusta, GA, USA). The significance of adrenal and ovarian catheterization in patients with polycystic ovary syndrome. Int J Gynaecol Obstet 17:78-82, 1979 A previously unreported series of 15 anovulatory hirsute women with polycystic ovaries made up this study. Each underwent left adrenal and left ovarian vein catherization. Blood samples were obtained from the ovarian, adrenal and peripheral veins to lest the levels of testosterone, A androstenedione (A4A), dehydroepiandrosterone (DHEA), estradiol and/or total estrogens, before and after administration of human chorionic gonadotropin (ten cases) and adrenocorticotropic hormone (ACTH) (five cases). Following intravenous human chorionic gonadotropin administration, the only response seen was a slight rise in ovarian levels of A A and DHEA; after intravenous adrenocorticotropic hormone stimulation, the adrenal levels of A A, testosterone and DHEA rose significantly. Peripheral concentrations of testosterone and A A were in the high normal range and DHEA levels were high normal or slightly above normal range.
INTRODUCTION Ovarian and adrenal vein catheterizations have been performed by various investigators to study the source of androgens in women with idiopathic hirsutism and in those with polycystic ovary syndrome (6, 10, 12). Testing affords little information in ovulatory hirsute women if performed during the luteal phase because of the discordant values between the ovary with the corpus luteum and contralateral ovary (12). Furthermore, such factors as stress V. Tzingounis, M. F. Aksu and P. K. Natrajan are Research Fellows of Endocrinology, Medical College of Georgia, Augusta, GA, USA.
InlJ Gynaecol Obstet 17
and the episodic nature of secretions by these glands may result in marked variability in hormone levels. This study was performed to learn what information could be obtained on androgen and estrogen secretion in anovulatory hirsute women with polycystic ovaries before and after ovarian and adrenal stimulation tests.
MATERIALS A N D M E T H O D S Fifteen women diagnosed as having polycystic ovaries constituted the study (Table I). Selective venous catheterizations of the left adrenal vein, left ovarian and right femoral vein were performed, as described elsewhere (12). Following a control sampling, ten patients received 5000 IU of h u m a n chorionic gonadotropin (HCG), and five received 40 IU of adrenocorticotropic hormone (ACTH) intravenously. Blood samples were obtained at 0, 10, 20 and 30 minutes. Serum was obtained and stored at —20 C pending radioimmunologic determination for testosterone (T), A4A androstenedione (A4A), dehydroepiandrosterone (DHEA), estradiol (E2) a n d / o r total estrogens (2-4, 13). Baseline serum gonadotropins (follicle-stimulating hormone and luteinizing hormone) and prolactin were also measured (7, 9, 11). Statistical analysis was done using the Student's I test.
RESULTS T h e ten patients in whom H C G was administered had peripheral baseline values within the normal range for E2, T and A4A, but their D H E A values were elevated. Twenty minutes following H C G stimulation, a significant response was obtained in ovarian values of A4A (p < 0.05) (Fig. 1). In the five patients who received A C T H , periph-
Adrenal and ovarian catheterization
eral values for A4A, D H E A , T and E2 were within the normal range. T e n minutes after A C T H infusion, the adrenal values of A4A, T and D H E A rose significantly (p < 0.01 and p < 0.05, respectively) (Fig. 2). The results were not impressive, except in two cases. Of these, one patient received HCG, the other A C T H . These two cases are presented in detail.
79
uterus was small and, on endometrial biopsy, a proliferative endometrium was obtained. Hysterosalpingogram revealed enlargement of both ovaries, measuring approximately 5 X 7 cm. Venous catheterization was performed and samples from left ovarian and left adrenal veins were taken before and after intravenous administration of H C G (Fig. 3).
Case 1 A 32-year-old woman presented with severe hirsutism, obesity and oligomenorrhea (Table I). She menstruated at four- to six-month intervals. Her
FSH
The Significance of Adrenal and Ovarian Catheterization in Patients with Polycystic Ovary Syndrome Vassilios A. Tzingounis, M. Feridun Aksu, Puthugramam K. Natrajan and Robert B. Greenblatt Medical College of Georgia, Augusta, Georgia, USA
ABSTRACT Tzingounis VA, Aksu MF, Natrajan PK, Greenblatt RB (Medical College of Georgia, Augusta, GA, USA). The significance of adrenal and ovarian catheterization in patients with polycystic ovary syndrome. Int J Gynaecol Obstet 17:78-82, 1979 A previously unreported series of 15 anovulatory hirsute women with polycystic ovaries made up this study. Each underwent left adrenal and left ovarian vein catherization. Blood samples were obtained from the ovarian, adrenal and peripheral veins to lest the levels of testosterone, A androstenedione (A4A), dehydroepiandrosterone (DHEA), estradiol and/or total estrogens, before and after administration of human chorionic gonadotropin (ten cases) and adrenocorticotropic hormone (ACTH) (five cases). Following intravenous human chorionic gonadotropin administration, the only response seen was a slight rise in ovarian levels of A A and DHEA; after intravenous adrenocorticotropic hormone stimulation, the adrenal levels of A A, testosterone and DHEA rose significantly. Peripheral concentrations of testosterone and A A were in the high normal range and DHEA levels were high normal or slightly above normal range.
INTRODUCTION Ovarian and adrenal vein catheterizations have been performed by various investigators to study the source of androgens in women with idiopathic hirsutism and in those with polycystic ovary syndrome (6, 10, 12). Testing affords little information in ovulatory hirsute women if performed during the luteal phase because of the discordant values between the ovary with the corpus luteum and contralateral ovary (12). Furthermore, such factors as stress V. Tzingounis, M. F. Aksu and P. K. Natrajan are Research Fellows of Endocrinology, Medical College of Georgia, Augusta, GA, USA.
InlJ Gynaecol Obstet 17
and the episodic nature of secretions by these glands may result in marked variability in hormone levels. This study was performed to learn what information could be obtained on androgen and estrogen secretion in anovulatory hirsute women with polycystic ovaries before and after ovarian and adrenal stimulation tests.
MATERIALS A N D M E T H O D S Fifteen women diagnosed as having polycystic ovaries constituted the study (Table I). Selective venous catheterizations of the left adrenal vein, left ovarian and right femoral vein were performed, as described elsewhere (12). Following a control sampling, ten patients received 5000 IU of h u m a n chorionic gonadotropin (HCG), and five received 40 IU of adrenocorticotropic hormone (ACTH) intravenously. Blood samples were obtained at 0, 10, 20 and 30 minutes. Serum was obtained and stored at —20 C pending radioimmunologic determination for testosterone (T), A4A androstenedione (A4A), dehydroepiandrosterone (DHEA), estradiol (E2) a n d / o r total estrogens (2-4, 13). Baseline serum gonadotropins (follicle-stimulating hormone and luteinizing hormone) and prolactin were also measured (7, 9, 11). Statistical analysis was done using the Student's I test.
RESULTS T h e ten patients in whom H C G was administered had peripheral baseline values within the normal range for E2, T and A4A, but their D H E A values were elevated. Twenty minutes following H C G stimulation, a significant response was obtained in ovarian values of A4A (p < 0.05) (Fig. 1). In the five patients who received A C T H , periph-
Adrenal and ovarian catheterization
eral values for A4A, D H E A , T and E2 were within the normal range. T e n minutes after A C T H infusion, the adrenal values of A4A, T and D H E A rose significantly (p < 0.01 and p < 0.05, respectively) (Fig. 2). The results were not impressive, except in two cases. Of these, one patient received HCG, the other A C T H . These two cases are presented in detail.
79
uterus was small and, on endometrial biopsy, a proliferative endometrium was obtained. Hysterosalpingogram revealed enlargement of both ovaries, measuring approximately 5 X 7 cm. Venous catheterization was performed and samples from left ovarian and left adrenal veins were taken before and after intravenous administration of H C G (Fig. 3).
Case 1 A 32-year-old woman presented with severe hirsutism, obesity and oligomenorrhea (Table I). She menstruated at four- to six-month intervals. Her
FSH
