DETECTION OF FUNCTIONAL OVARIAN HYPERANDROGENISM IN WOMEN WITH ANDROGEN EXCESS
DETECTION OF FUNCTIONAL OVARIAN HYPERANDROGENISM IN WOMEN WITH ANDROGEN EXCESS
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DOI：
10.1056/nejm199207163270304
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发表时间：
1992-07-16
影响因子：
158.5
通讯作者：
SHEIKH, Z
中科院分区：
文献类型：
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作者：
EHRMANN, DA;ROSENFIELD, RL;SHEIKH, Z
背景。区分卵巢和肾上腺的雄激素过量的原因可能是困难的。我们发现患有多囊卵巢综合征的妇女对促性腺激素释放激素激动剂纳弗雷林有异常的血浆17-羟孕酮反应。我们确定了纳伐林试验在区分女性高雄激素症卵巢病因方面的有效性。我们连续研究了40名患有雄激素过多症的女性，她们有少月经、多毛或痤疮。所有40例患者均接受了纳伐林、地塞米松和促肾上腺皮质激素的检测，并测量了促性腺激素和类固醇激素的循环浓度，19例患者接受了卵巢超声检查。40名妇女中有23名（58%）血浆17-羟孕酮对纳伐林的反应异常，23名血浆雄激素对促肾上腺皮质激素的反应升高；13名女性同时出现了这两种异常。只有一名妇女有确凿证据表明存在类固醇性阻滞；她患有非典型肾上腺21-羟化酶缺乏症。在对纳伐林有异常反应的23名妇女中，只有11名（48%）血清黄体生成素基线浓度升高。在接受超声检查的13名对纳伐林有异常反应的妇女中，有7名（54%）患有多囊卵巢。纳伐林给药后血浆17-羟孕酮峰值浓度与地塞米松给药后血浆游离睾酮浓度密切相关(r = 0.75， P
Background. Distinguishing between ovarian and adrenal causes of androgen excess may be difficult. We have found that women with the polycystic ovary syndrome have supranormal plasma 17-hydroxyprogesterone responses to the gonadotropin-releasing hormone agonist nafarelin. We determined the usefulness of testing with nafarelin to distinguish ovarian causes of hyperandrogenism in women.Methods. We studied 40 consecutive women with hyperandrogenism who had oligomenorrhea, hirsutism, or acne. All 40 underwent testing with nafarelin, dexamethasone, and corticotropin with measurement of circulating concentrations of gonadotropins and steroid hormones, and 19 underwent ovarian ultrasonography.Results. The plasma 17-hydroxyprogesterone response to nafarelin was supranormal in 23 of the 40 women (58 percent), and the plasma androgen response to corticotropin was elevated in 23; 13 women had both abnormalities. Only one woman had conclusive evidence of a steroidogenic block; she had nonclassic adrenal 21-hydroxylase deficiency. Of the 23 women with abnormal responses to nafarelin, only 11 (48 percent) had elevated base-line serum luteinizing hormone concentrations. Of the 13 women with abnormal responses to nafarelin who underwent ultrasonography, 7 (54 percent) had polycystic ovaries. Peak plasma 17-hydroxyprogesterone concentrations after nafarelin administration correlated closely with plasma free testosterone concentrations after dexamethasone administration (r = 0.75, P