Effect of bilateral oophorectomy on adrenocortical function in women with polycystic ovary syndrome

Objective: To determine the impact of ovary-secreted products on adrenocortical function in women with PCOS by studying the adrenocortical response to acute adrenocorticotropic-stimulating hormone (ACTH) stimulation before and after bilateral oophorectomy. Design: Prospective study. Setting: Tertiary care medical center. Patient(s): Fourteen women with PCOS, scheduled for bilateral oophorectomy for benign indications, on postoperative transdermal estradiol (E-2). Intervention(s): Physical examination, blood sampling before and after oophorectomy, measurement of hormone levels; assessment of basal (Steroid(0)), maximum stimulated (Steroid(60)), and net increment (Delta Steroid) levels of androstenedione (A4), dehydroepiandrosterone (DHEA), and cortisol (F) before and after ACTH 1-24 stimulation. Main Outcome Measure(s): Preoperative and postoperative basal and ACTH (1-24) stimulated hormone levels. Result(s): Total testosterone, free testosterone, and estrone levels decreased, and follicle-stimulating hormone levels statistically significantly increased after oophorectomy. No statistically significant differences in E-2, DHEA sulfate (DHEAS), or sex hormone-binding globulin levels were detected. Basal and ACTH-stimulated A4 levels statistically significantly decreased after oophorectomy, and Delta A4 was statistically significantly increased. No statistically significant differences in DHEA(0), DHEA(60), or F-0 levels were detected. The F-60 and Delta F levels tended to increase after oophorectomy, but the differences did not reach statistical significance. Conclusion(s): Ovarian factors do not appear to contribute significantly to the adrenocortical dysfunction of PCOS. (Fertil Steril (R) 2013; 99: 599-604. (C) 2013 by American Society for Reproductive Medicine.)