Purpose: to test the adrenal function by a potent stimulus to its reticular layer verifying 3beta-hydroxysteroid dehy-drogenase (3beta-HSD) and 21-hydroxylase (21OH) enzymatic activities. Methods: plasma concentrations of 17alphaOH-pregneno-lone, 17alphaOH-progesterone, cortisol, progesterone, androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (SDHEA) and free testosterone were determined in 39 women, 13 of whom were normal (2 of them used in a pilot study) and 26 had idiopathic hirsutism, 0, 12 and 24 h after injection of ACTH-depot. Results: among hirsute women, we identified different responses that could diagnose any blockage in the steroid pathways leading to the diagnosis of a mild/moderate decreased adrenal function. The 17alphaOH-pregnenolone concentrations varied from 2.0 to 24.6 ng/mL, cortisol values increased from 2.1 to 45.3 and 38.4 mug/dL, 17alphaOH-progesterone levels varied from 50.7 to 346 and 218 ng/mL and progesterone increased from 0.3 to 4.4 and 2.2 ng/mL. Among the reticular layer hormones a rise of SDHEA from 274.7 to 495.5 and 505.8 mg/dL, and of androsterone from 1.1 to 4.0 and 4.5 ng/mL was observed, the levels of free testosterone increased from 1.3 to 1.8 and 2.7 pg/mL and the DHEA levels from 2.4 to 4.7 and 8.5 ng/mL. One patient showed 3beta-HSD deficiency and two others a possible 21OH deficiency. Conclusions: these findings suggest that the ACTH-depot test could be used to exclude the adrenal gland as the possible source of hyperandrogenism in women with idiopathic hirsutism.
Hirsutism; ACTH; Adrenal hyperplasia
