Hormone replacement therapy increases ACTH/dehydroepiandrosterone sulfate in menopause

Objective: To demonstrate that hypoestrogenism in menopause is in part responsible for the decrease in circulating dehydroepiandrosterone sulfate (DHEA-S) and ACTH levels. To test this hypothesis, 25 postmenopausal women aged 47-60 years, were given orally conjugated equine estrogen (CEE) to study the effect on circulating DHEA-S, cortisol and ACTH. Design: A prospective, non-blinded study was performed. Hormonal levels were analyzed before and after three cycles of CEE 0.625 mg/day for 21 days followed each by chlormadinone acetate for 5 days. Results: Low baseline levels of DHEA-S increased significantly after HRT (1.71 +/- 0.75 to 3.3 +/- 1.5 mu mol/l, (P < 0.001). ACTH levels augmented moderately from 3.26 +/- 1.4 to 4.7 +/- 1.8 pmol/l (P < 0.05) and cortisol from 350.4 +/- 118 to 450.8 +/- 144 nmol/l (P < 0.01). A positive correlation was obtained between 17 beta -estradiol and ACTH (r = 0.48), estradiol and cortisol (r = 0.52) as well as estradiol and DHEA-S (r = 0.60). In addition, the correlation was highly significant (P < 0.001) between ACTH and DHEA-S at the term of HRT. Conclusion: HRT increased DHEA-S, ACTH and cortisol concentrations, which may suggest that this therapy may exert a stimulatory effect on the pituitary gland when baseline hypoestrogenism is present, but further studies are required to clarify the mechanism underlying this process. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.