PCOS Forum

Research in Polycystic Ovary Syndrome Today and Tomorrow

Renato Pasquali; Elisabet Stener-Victorin; Bulent O. Yildiz; Antoni J. Duleba; Kathleen Hoeger; Helen Mason; Roy Homburg; Theresa Hickey; Steve Franks; Juha S. Tapanainen; Adam Balen; David H. Abbott; Evanthia Diamanti-Kandarakis; Richard S. Legro


Clin Endocrinol. 2011;74(4):424-433. 

In This Article

Defining Alterations of Steroidogenesis in PCOS

In normal women, androgen production rate (PR) is the result of adrenal and ovarian secretion and conversion from precursors in peripheral tissues, particularly the adipose tissue and skin.[5] Similarly, the metabolic clearance rate (MCR) of androgens may occur in both glandular and extraglandular tissues. Both PR and MCR of androgens in females depend on age and physiological status. All androgens exhibit a daily rhythm, less variable for androstenedione and testosterone than that of dehydroepiandrosterone (DHEA) and cortisol. A few studies, all performed several decades ago, documented higher PRs for both androstenedione and testosterone in women with PCOS, associated with a less pronounced increase in their MCR.[6] In addition, it was shown that testosterone MCR was higher in obese PCOS women and varied according to its PR, whereas MCR of androstenedione was marginally different with respect to normal weight affected women, suggesting that factors (peripheral conversion or possibly binding to sex hormone binding globulin) in addition to body size influenced testosterone MCR in PCOS women. Notably, there are no studies in PCOS women with different obesity phenotypes, although there is evidence that in women with simple obesity, those with abdominal fat distribution have higher testosterone PR, but not higher androstenedione, with respect to those with the peripheral phenotype.[7] Similar studies should therefore be replicated in PCOS women with different obesity phenotypes. Oestrogen and progesterone PRs in women with PCOS have been poorly investigated.

One of the main problems in the diagnosis of hyperandrogenic states such as PCOS is the accurate measurement of androgens and particularly testosterone.[8] Many radioimmunoassays, especially platform assays, for androgens are decidedly unsatisfactory. Most of these intrinsic methodological limitations are bypassed by the growing use of liquid chromatography–tandem mass spectrometry (LM/MS-MS), the modern gold standard for all steroid hormone measurement, particularly in women.[9] By the use of LM/MS-MS, it would be expected that additional kinetic studies in different phenotypes of this disorder may favour a better understanding of complex pathophysiological events leading to androgen excess in women with PCOS, as preliminary clinical studies seem to indicate.


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