Polycystic Ovary Syndrome with Adrenal Hyperandrogenemia and Refractory Hirsutism

This case study described a 26-year-old woman with polycystic ovary syndrome (PCOS) and adrenal hyperandrogenism (AH), whose hirsutism was resistant to conventional treatments. Despite treatment with oral contraceptives, spironolactone, and metformin, her hirsutism persisted, and she exhibited elevated levels of adrenal androgens. The study found that exaggerated responsiveness of the zona reticularis to ACTH was likely the primary cause of AH in PCOS, although the exact reason for increased ACTH sensitivity was unclear. The patient’s metabolic and imaging workup ruled out other potential causes of hirsutism. It was noted that women with AH-PCOS had reduced insulin sensitivity and an increased risk of hypertension, particularly in obese individuals. The study concluded that while glucocorticoid treatment improved adrenal androgen and testosterone levels, it did not significantly enhance ovulatory function or hirsutism and was linked to weight gain.