ADRENAL ANDROGENS ARE ELEVATED IN YOUNG WOMEN WITH ACNE AND/OR HIRSUTISM

Abstract

Because elevated androgens have recently been found in patients with acne(A) and/or hirsutism(H), we have studied 32 young adult females, 15-34 yrs, who came to a dermatologist (A=13, H=2, A+H=17). 29 of these subjects had elevated baseline plasma free testosterone and dehydroepiandrosterone(DHEA) sulfate levels. Each subject and 15 controls who had no significant A or H received 1.5 μg dexamethasone hs before the am infusion of 1-24 ACTH 10 μg/m² IV. One patient with acne had an abnormal response of 17α-hydroxyprogesterone(17 Prog) at 30' (383 ng/dl vs≤216) and 60' (551 vs≤230), diagnostic of the mild 21-hydroxylase deficiency form of congenital adrenal hyperplasia(CAH). 15 patients had abnormal responses of 17α-hydroxypregnenolone (17 Preg) at 30' (959-1858 ng/ml vs≤937) and 60'(1021-2620 vs≤981). DHEA and androstenedione(AD) were assayed in 18 subjects and abnormal responses were noted in 8 & 7 subjects respectively. Three patients (1=A, 2=A+H) had abnormal responses of 17 Preg and DHEA with normal responses of 17 Prog and AD suggestive of the 3 β-hydroxysteroid dehydrogenase form of CAH. The other patterns of elevated androgen response to ACTH could not be attributed to a single enzyme dysfunction. Elevated androgens may underlie acne and/or hirsutism. The adrenal contribution is significant, representing well-defined CAH syndromes as well as functional adrenal hyperresponsiveness to ACTH.

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