Polycystic Ovary Syndrome with Adrenal Hyperandrogenemia and Refractory Hirsutism

    April 2019 in “ Journal of the Endocrine Society ”
    Sanober Parveen, Hadoun Jabri, Anis Rehman, Michael Jakoby
    TLDR Glucocorticoid treatment lowered androgen levels but didn't improve hirsutism or ovulation and caused weight gain.
    The study presented a case of a 26-year-old Asian Indian female with polycystic ovary syndrome (PCOS) and adrenal hyperandrogenism (AH), characterized by hirsutism, obesity, and thinning scalp hair. Despite treatment with oral contraceptives, spironolactone, and metformin, her hirsutism persisted. Laboratory tests showed elevated levels of testosterone and dehydroepiandrosterone (DHEA), indicating an adrenal source of androgen. The study concluded that AH occurs in 25-50% of PCOS cases, often due to exaggerated responsiveness of the zona reticularis to ACTH. While glucocorticoid treatment reduced adrenal androgens and testosterone levels, it did not significantly improve ovulatory function or hirsutism and was associated with weight gain. Potential conditions mimicking AH-PCOS were ruled out through metabolic and imaging evaluations.
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