Adrenal steroidogenesis is related to insulin in hyperandrogenic women

Objective: To evaluate ovarian and adrenal steroid secretion in women with severe hyperandrogenism. Design: A prospective study. Setting: The Gynecological Endocrine Research Unit of the University Central Hospital, Oulu, Finland. Patients: Thirteen obese, hirsute women with severe hyperandrogenism. Interventions: Adrenocorticotropin hormone stimulation and dexamethasone suppression tests and selective catheterizations of the left ovarian and adrenal veins were performed. Main Outcome Measures: The concentrations of insulin, P, 17-hydroxyprogesterone (17-OHP), androstenedione (A), T, DHEA, DHEAS, and cortisol were measured. Results: The secretory gradients of T and its precursors, P, 17-OHP, A, and DHEA in the selective catheterizations showed the adrenal to be the main source of excessive steroid production in these patients. The concentrations of P (r=0.82), 17-OHP (r=0.89), A (r=0.84), T (r=0.86), and cortisol (r=0.87) in the adrenal vein showed a strong correlation with insulin measured from the same samples. Conclusions: Excessive androgens were secreted mainly by the adrenals in these obese hyperinsulinemic women. Correlation analyses suggested that insulin stimulates adrenal androgen and cortisol secretion, which may constitute an important component of the pathogenetic mechanisms of hyperandrogenism and the polycystic ovary syndrome.