Advertisement
AJOG Home
Advanced SearchSave search
Full length article| Volume 140, ISSUE 7, P815-830, August 01, 1981

Hirsutism: Implications, etiology, and management

  • Richard Hatch
    Correspondence
    Reprint requests: Richard Hatch, M.D., Department of Obstetrics and Gynecology, Chicago Lying-In-Hospital, Chicago, Illinois 60637
    Affiliations
    Department of Obstetrics and Gynecology, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Pediatrics, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Medicine, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Obstetrics and Gynecology, Ohio State University School of Medicine Columbus, Ohio, USA
    Search for articles by this author
  • Robert L. Rosenfield
    Affiliations
    Department of Obstetrics and Gynecology, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Pediatrics, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Medicine, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Obstetrics and Gynecology, Ohio State University School of Medicine Columbus, Ohio, USA
    Search for articles by this author
  • Moon H. Kim
    Affiliations
    Department of Obstetrics and Gynecology, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Pediatrics, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Medicine, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Obstetrics and Gynecology, Ohio State University School of Medicine Columbus, Ohio, USA
    Search for articles by this author
  • Donald Tredway
    Affiliations
    Department of Obstetrics and Gynecology, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Pediatrics, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Medicine, The University of Chicago Pritzker School of Medicine Chicago, Illinois, USA

    Department of Obstetrics and Gynecology, Ohio State University School of Medicine Columbus, Ohio, USA
    Search for articles by this author
DOI:https://doi.org/10.1016/0002-9378(81)90746-8
Hirsutism: Implications, etiology, and management
Previous ArticleThe impact of laparoscopy on tubal sterilization in United States hospitals, 1970 and 1975 to 1978
Next ArticleIntrauterine quadriplegia associated with breech presentation and hyperextension of fetal head: A case report
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Hirsutism usually results from a subtle excess of androgens. As such, it is a clue to possible endocrine disturbance in addition to presenting cosmetic problems. We use the term hirsutism to mean male-pattern hirsutism—excessive growth of hair in areas where female subjects normally have considerably less than male subjects. An elevation of the plasma free (unbound) testosterone level is the single most consistent endocrinologic finding in hirsutism. The plasma free testosterone level is sometimes elevated when the total level of plasma testosterone is normal because testosterone-estradiol-binding globulin (TEBG) levels are often depressed in hirsute women. Frequent blood sampling is sometimes necessary to demonstrate subtle hyperandrogenic states since androgen levels in the blood are pulsatile and seemingly reflect episodic ovarian and adrenal secretion. The source of hyperandrogenemia can usually be determined from dexamethasone suppression testing. Those patients whose plasma free androgen levels do not suppress normally usually have functional ovarian hyperandrogenism (polycystic ovary syndrome variants). Very high plasma androgen levels or evidence of hypercortisolism, which is not normally suppressible by dexamethasone, should lead to the search for a tumor or Cushing's syndrome. Those patients in whom hyperandrogenemia is suppressed normally by dexamethasone have a form of the adrenogenital syndrome, a prolactinoma, obesity, or idiopathic hyperandrogenemia. In such patients, glucocorticoid therapy may reduce hirsutism and acne and normalize menses. The treatment of hirsutism resulting from functional ovarian hyperandrogenism is not as satisfactory; estrogen-progestin treatment is the most useful adjunct to cosmetic approaches to hirsutism in this country. However, other manifestations of polycystic ovary syndrome, such as infertility, may take precedence over hirsutism when an optimal therapeutic program is designed for many patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Ferriman D.
        • Gallwey J.D.
        Clinical assessment of body hair growth in women.
        J. Clin. Endocrinol. Metab. 1961; 21: 1440
        • Lorenzo E.M.
        Familial study of hirsutism.
        J. Clin. Endocrinol. Metab. 1970; 31: 556
        • Hamilton J.B.
        • Terada H.
        Interdependence of genetic, aging, and endocrine factors in hirsutism.
        in: Greenblatt R.B. The Hirsute Woman. Charles C Thomas, Publisher, Springfield, Illinois1962: 20
        • Rosenfield R.L.
        • Lucky A.W.
        • Allen T.D.
        The diagnosis and management of intersex.
        Curr. Prob. Pediatr. 1980; 10 (Monograph.)
        • Wilson J.D.
        • Walker J.D.
        The conversion of testosterone to 5α-androstan-17β-ol-3-one(dihydrotestosterone) by skin slices of man.
        J. Clin. Invest. 1969; 48: 371
        • Liao S.
        Molecular action of androgens.
        in: Biochemical Actions of Hormones. vol. 5. Academic Press, Inc, New York1977: 351-406
        • Abraham G.E.
        • Maroulis G.B.
        • Buster J.E.
        • Chang R.J.
        • Marshall J.R.
        Effect of dexamethasone on serum cortisol and androgen levels in hirsute patients.
        Obstet. Gynecol. 1975; 47: 395
        • Rosenfield R.L.
        Studies of the relation of plasma androgen levels to androgen action in women.
        J. Steroid Biochem. 1975; 6: 695
        • Rosenfield R.L.
        Role of androgens in growth and development of the fetus, child and adolescent.
        Adv. Pediatr. 1972; 19: 171
        • Rosenfield R.L.
        • Ehrlich E.N.
        • Cleary R.E.
        Adrenal and ovarian contributions to the elevated free plasma androgen levels in hirsute women.
        J. Clin. Endocrinol. Metab. 1972; 34: 92
        • Rich B.H.
        • Rosenfield R.L.
        • Lucky A.W.
        • et al.
        Adrenarche: Changing adrenal response to ACTH.
        J. Clin. Endocrinol. Metab. 1981; 52: 1129
        • Fragachan F.
        • Nowaczynski W.
        • Bertranu E.
        • Kalina M.
        • Genest J.
        Evidence of in vivo inhibition of 11β-hydroxylation of steroids by dehydroepiandrosterone in the dog.
        J. Endocrinol. 1969; 84: 98
        • Lim N.Y.
        • Dingman J.F.
        Androgenic adrenal hyperfunction in acromegaly.
        N. Engl. J. Med. 1964; 271: 1189
        • Vermeulen A.
        • Ando S.
        Prolactin and adrenal androgen secretion.
        Clin. Endocrinol. 1978; 8: 295
        • Carter J.N.
        • Tyson J.E.
        • Warne G.L.
        • McNeilly A.S.
        • Faiman C.
        • Friesen H.G.
        Adrenocortical function in hyperprolactinemic women.
        J. Clin. Endocrinol. Metab. 1977; 45: 973
        • Parker L.N.
        • Odell W.D.
        Evidence for existence of cortical androgen-stimulating hormone.
        Am. J. Physiol. 1979; 236: E616
        • McNatty K.P.
        • Makris A.
        • DeGrazia C.
        • Osathanondh R.
        • Ryan K.J.
        The production of progesterone, androgens, and estrogens by granulosa cells, thecal tissue, and stromal tissue from human ovaries in vitro.
        J. Clin. Endocrinol. Metab. 1979; 49: 687
        • Tsang B.K.
        • Armstrong D.T.
        • Whitfield J.F.
        Steroid biosynthesis by isolated human ovarian follicular cells in vitro.
        J. Clin Endocrinol. Metab. 1980; 51: 1407
        • Rivarola M.A.
        • Singleton R.T.
        • Migeon C.J.
        Splanchnic extraction and interconversion of testosterone and androstenedione in man.
        J. Clin. Invest. 1967; 46: 2095
        • Mauvais-Jarvis P.
        • Vercovici J.P.
        • Crepy O.
        • Gauthier F.
        Studies on testosterone metabolism in subjects with testicular feminization syndrome.
        J. Clin. Invest. 1970; 49: 31
        • Nimrod A.
        • Ryan K.J.
        Aromatization of androgens by human abdominal and breast fat tissue.
        J. Clin. Endocrinol. Metab. 1975; 40: 367
        • Edman C.D.
        • MacDonald P.C.
        Effect of obesity on conversion of plasma androstenedione to estrone in ovulatory and anovulatory young women.
        Am. J. Obstet. Gynecol. 1978; 130: 456
        • Ganong W.F.
        • Alpert L.C.
        • Lee T.C.
        ACTH and the regulation of ACTH secretion.
        N. Engl. Med. 1974; 290: 1006
        • Bogumil R.T.
        • Ferin M.
        • Rotenberg J.
        • Speroff L.
        • Vande Wiele R.L.
        Mathematical studies of the human menstrual cycle. I. Formulation of a mathematical model.
        J. Clin. Endocrinol. Metab. 1972; 35: 126
        • Razdan A.K.
        • Rosenfield R.L.
        • Kim M.H.
        Endocrinologic characteristics of partial ovarian failure.
        J. Clin. Endocrinol. Metab. 1976; 43: 449
        • De Moor P.
        • Denef C.
        The “puberty” of the rat liver. Feminine pattern of cortisol metabolism in male rats castrated at birth.
        Endocrinology. 1968; 82: 480
        • Vermeulen A.
        • Verdonck L.
        • van der Straeten M.
        • Orie N.
        Capacity of the testosterone-binding globulin in human plasma and influence of specific binding of testosterone on its metabolic clearance rate.
        J. Clin. Endocrinol. Metab. 1969; 29: 1470
        • Moll Jr., G.W.
        • Rosenfield R.L.
        Testosterone binding and free plasma androgen concentrations under physiological conditions: Characterization by flow dialysis technique.
        J. Clin. Endocrinol. Metab. 1979; 49: 730
        • Pardridge W.M.
        • Mietus L.J.
        Transport of steroid hormones through the rat blood-brain barrier; primary role of albumin-bound hormone.
        J. Clin. Invest. 1979; 64: 145
        • Takayasu S.
        Metaboklism and action of androgen in the skin.
        Int. J. Dermatol. 1979; 18: 681
        • Attramadal A.
        • Weddington S.C.
        • Naess O.
        • Djoseland O.
        • Hansson V.
        Androgen receptors in male sex tissues of rats and humans.
        in: Marberger H. Prostate Diseases. Alan Liss, New York1976: 189-203
        • Nimrod A.
        • Rosenfield R.L.
        • Otto P.
        Relationship of androgen action to androgen metabolism in isolated rat granulosa cells.
        J. Steroid Biochem. 1980; 13: 1015
        • Peterson R.W.
        • Imperato-McGinley J.
        • Gautier T.
        • Sturla E.
        Male pseudohermaphroditism due to steroid 5α-reductase deficiency.
        Am. J. Med. 1977; 62: 170
        • Imperato-McGinley J.
        • Peterson R.E.
        • Leshin M.
        • Griffin J.E.
        • Cooper G.
        • Draghi S.
        • Bereny M.
        • Wilson J.D.
        Steroid 5α-reductase deficiency in a 65-year-old male pseudohermaphrodite: The natural history, ultrastructure of the testes, and evidence for inherited enzyme heterogeneity.
        J. Clin. Endocrinol. Metab. 1980; 50: 15
        • Schweikert H.U.
        • Wilson J.D.
        Regulation of human hair growth by steroid hormones. I. Testosterone metabolism in isolated hairs.
        J. Clin. Endocrinol. Metab. 1974; 38: 811
        • Schweikert H.U.
        • Wilson J.D.
        Regulation of human hair growth by steroid hormones. II. Androstenedione metabolism in isolated hairs.
        J. Clin. Endocrinol. Metab. 1974; 39: 1012
        • Hay J.B.
        • Hodgins M.B.
        Distribution of androgen metabolizing enzymes in isolated tissues of human forehead and axillary skin.
        J. Endocrinol. 1978; 79: 29
        • Maroulis G.B.
        • Manlimos F.S.
        • Abraham G.E.
        Comparison between urinary 17-ketosteroids and serum androgens in hirsute patients.
        Obstet. Gynecol. 1977; 49: 454
        • Judd H.L.
        • McPherson R.A.
        • Rekoff J.S.
        • Yen S.S.C.
        Correlation of the effects of dexamethasone administration on urinary 17-ketosteroid and serum androgen levels in patients with hirsutism.
        Am. J. Obstet. Gynecol. 1977; 128: 408
        • Rosenfield R.L.
        Plasma testosterone binding globulin and indexes of the concentration of unbound androgens in normal and hirsute subjects.
        J. Clin. Endocrinol. Metab. 1971; 32: 717
        • Vermeulen A.
        • Stoica T.
        • Verdonck F.
        The apparent free testosterone concentration, an index of androgenicity.
        J. Clin. Endocrinol. Metab. 1971; 33: 759
        • Heinrichs W.L.
        • Tabei T.
        • Kuwabara Y.
        • Burry K.
        • Resko J.
        • Petra P.
        • Shiller H.
        • Namkung P.
        Differentiation and regulation of peripheral androgen metabolism in rats and rheusus monkeys.
        Am. J. Obstet. Gynecol. 1979; 135: 974
        • Rosenfield R.L.
        Plasma free androgen patterns in hirsute women and their diagnostic implications.
        Am. J. Med. 1979; 66: 417
        • Kirschner M.A.
        • Zucker R.I.
        • Jespersen D.
        Idiopathic hirsutism—an ovarian abnormality.
        N. Engl. J. Med. 1976; 294: 637
        • Kim M.H.
        • Rosenfield R.L.
        • Hosseinian A.H.
        • Schneir H.G.
        Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries.
        Am. J. Obstet Gynecol. 1979; 134: 445
        • Abraham G.E.
        Ovarian and adrenal contribution to peripheral androgens during the menstrual cycle.
        J. Clin. Endocrinol. Metab. 1974; 39: 340
        • Kim M.H.
        • Rosenfield R.L.
        • Dupon D.
        The effects of dexamethasone on plasma free androgens during the normal menstrual cycle.
        Am. J. Obstet. Gynecol. 1976; 126: 982
        • Cortes-Gallegos N.
        • Gallegos A.J.
        • Bedolla T.
        • Cervantes A.
        • Parra A.
        Effect of paramethasone acetate on ovarian steroids and gonadotropins. 1. Normal menstrual cycle.
        J. Clin. Endocrinol. Metab. 1975; 41: 215
        • Hagino N.
        The effect of synthetic corticosteroids on ovarian function in the baboon.
        J. Clin. Endocrinol. Metab. 1972; 35: 716
        • Stahl N.L.
        • Teeslink C.R.
        • Greenblatt R.B.
        Ovarian, adrenal, and peripheral testosterone levels in the polycystic ovary syndrome.
        Am. J. Obstet. Gynecol. 1973; 117: 194
        • Parker Jr., C.R.
        • Bruneteau D.W.
        • Greenblatt R.
        • Mahesh V.B.
        Peripheral, ovarina, and adrenal vein steroids in hirsute women: acute effects of human chorionic gonadotropin and on adrenocorticotrophic hormone.
        Fertil. Steril. 1975; 26: 877
        • Hellman L.
        • Nakada F.
        • Curti J.
        • Weitzman E.D.
        • Kream J.
        • Roffwarg H.
        • Ellman S.
        • Fukushima D.K.
        • Gallagher T.F.
        Cortisol is secreted episodically by normal man.
        J. Clin. Endocrinol. Metab. 1970; 30: 411
        • Spark R.F.
        • Kettyle W.R.
        • Eisenberg H.
        Cortisol dynamics in the adrenal venous effluent.
        J. Clin. Endocrinol. Metab. 1974; 39: 305
        • Huq M.S.
        • Pfaff J.
        • Jespersen D.
        • Zucker I.R.
        • Kirschner M.A.
        Concurrence of aldosterone, androgen, and cortisol secretion in adrenal venous effluent.
        J. Clin. Endocrinol. Metab. 1976; 42: 230
        • DeJong F.H.
        • Baird D.T.
        • Van der Molen H.J.
        Ovarian secretion rates of oestrogens, androgens and progesterone in normal women and in women with persistent ovarian follicles.
        Acta. Endocrinol. 1974; 77: 575
        • Wentz A.C.
        • White R.I.
        • Migeon C.J.
        • Hsu T.H.
        • Barnes H.V.
        • Jones G.S.
        Differential ovarian and adrenal vein catheterization.
        Am. J. Obstet. Gynecol. 1976; 125: 1000
        • Baulieu E.-E.
        • Corpechot C.
        • Dray F.
        • Emiliozzi R.
        • Lebeau M.C.
        • Mauvais-Jarvis P.
        • Robel P.
        An adrenal-secreted “androgen”: dehydroisoandrosterone sulfate. Its metabolism and a tentative generalization on the metabolism of other steroid conjugates in man.
        Recent Prog. Horm. Res. 1965; 21: 411
        • Rosenfield R.L.
        • Rich B.H.
        • Wolfsdorf J.I.
        • Cassorla F.
        • Parks J.S.
        • Bongiovanni A.M.
        • Wu C.H.
        • Shackleton C.H.L.
        Pubertal presentation of congenital Δ5-3β-hydroxysteroid dehydrogenase deficiency.
        J. Clin. Endocrinol. Metab. 1980; 51: 345
        • Blankstein J.
        • Faiman C.
        • Reyes F.I.
        • Schroeder M.L.
        • Winter J.S.D.
        Adult-onset familial adrenal 21-hydroxylase deficiency.
        Am. J. Med. 1980; 68: 441
        • New M.I.
        • Lorenzen F.
        • Pang S.
        • Gunczler P.
        • DuPont B.
        • Levine L.S.
        “Acquired” adrenal hyperplasia with 21-hydroxylase deficiency is not the same genetic disorder as congenital adrenal hyperplasia.
        J. Clin. Endocrinol. Metab. 1979; 48: 356
        • Rosenwaks Z.
        • Lee P.A.
        • Jones G.S.
        • Migeon C.J.
        • Wentz A.C.
        An attenuated form of congenital virilizing adrenal hyperplasia.
        J. Clin. Endocrinol. Metab. 1979; 49: 335
        • Gabrilove J.L.
        • Sharma D.C.
        • Dorfman R.I.
        Adrenocorticol 11β-hydroxylase deficiency and virilism first manifest in the adult woman.
        N. Engl. J. Med. 1965; 272: 1189
        • Nicolis G.L.
        • Gabrilove J.L.
        Studies on the efficiency of adrenocorticol 11β-hydroxylation in the human subject.
        J. Clin. Endocrinol. Metab. 1969; 29: 831
        • Givens J.R.
        • Andersen R.N.
        • Ragland J.B.
        • Wiser W.L.
        • Unstot E.S.
        Adrenal function in hirsutism. I. Diurnal change and response of plasma androstenedione, testosterone, 17-hydroxyprogesterone, cortisol, LH and FSH to dexamethasone and ½ unit of ACTH.
        J. Clin. Endocrinol. Metab. 1975; 40: 988
        • Newmark S.
        • Dluhy R.G.
        • Williams G.H.
        • Pochi P.
        • Rose L.I.
        Partial 11- and 21-hydroxylase deficiencies in hirsute women.
        Am. J. Obstet. Gynecol. 1977; 127: 594
        • Lee P.A.
        • Gareis F.J.
        Evidence for partial 21-hydroxylase deficiency among heterozygote carriers of congenital adrenal hyperplasia.
        J. Clin. Endocrinol. Metab. 1975; 41: 414
        • Glickman S.M.
        • Rosenfield R.L.
        • Rich B.H.
        • Lucky A.W.
        • Hatch R.
        Dexamethasone suppression and dehydroepiandrosterone-SO4 as markers for adult-onset androgenital syndrome in hirsute women.
        Clin. Res. 1980; 28: 720A
        • Lachelin G.C.L.
        • Barnett M.
        • Hopper B.R.
        • Brink G.
        • Yen S.S.C.
        Adrenal function in normal women and women with the polycystic ovary syndrome.
        J. Clin. Endocrinol. Metab. 1979; 49: 892
        • Goldzieher M.W.
        • Green J.A.
        The polycystic ovary. I. Clinical and histologic features.
        J. Clin. Endocrinol. Metab. 1962; 22: 235
        • Givens J.R.
        • Wiser W.L.
        • Coleman S.A.
        • Wilroy R.S.
        • Andersen R.N.
        • Fish S.A.
        Familial ovarian hyperthecosis: A study of two families.
        Am. J. Obstet. Gynecol. 1971; 110: 959
        • Judd H.L.
        • Scully R.E.
        • Herbst A.L.
        • Yen S.S.C.
        • Ingersol F.M.
        • Kliman B.
        Familial hyperthecosis: comparison of endocrinologic and histologic findings with polycystic ovarian disease.
        Am. J. Obstet. Gynecol. 1973; 117: 976
        • Karam K.
        • Hajj S.
        Hyperthecosis syndrome.
        Acta Obstet. Gynecol. Scand. 1979; 58: 73
        • Abraham G.E.
        • Buster J.E.
        Peripheral and ovarian steroids in ovarian hyperthecosis.
        Obstet. Gynecol. 1976; 47: 581
        • Aiman J.
        • Edman C.D.
        • Worley R.J.
        • Vellios F.
        • MacDonald P.C.
        Androgen and estrogen formation in women with ovarian hyperthecosis.
        Obstet. Gynecol. 1978; 51: 1
        • Axelrod L.R.
        • Goldzieher J.W.
        The polycystic ovary. III. Steroid biosynthesis in normal and polycystic ovarian tissue.
        J. Clin. Endocrinol. Metab. 1962; 22: 431
        • Mahesh V.B.
        • Greenblatt R.B.
        • Aydar C.K.
        • Roy S.
        Secretion of androgens by the polycystic ovary and its significance.
        Fertil. Steril. 1962; 13: 513
        • Erickson G.F.
        • Hsueh A.J.W.
        • Quigley M.E.
        • Rebar R.W.
        • Yen S.S.C.
        Functional studies of aromatase activity in human granulosa cells from normal and polycystic ovaries.
        J. Clin. Endocrinol. Metab. 1979; 49: 514
        • McNatty K.P.
        • Smith D.M.
        • Makris A.
        • DeGrazia C.
        • Osathanondh R.
        • Schiff I.
        • Ryan K.J.
        The intraovarian sites of androgen and estrogen formation in normal and hyperandrogenic ovaries as judged by in vitro experiments.
        J. Clin. Endocrinol. Metab. 1980; 50: 755
        • Louvet J.-P.
        • Harman S.M.
        • Schreiber J.R.
        • Ross G.T.
        Evidence for a role of androgens in follicular maturation.
        Endocrinology. 1975; 97: 366
        • Yen S.S.
        • Vela C.P.
        • Rankin J.
        Inappropriate secretion of follicle-stimulating hormone and luteinizing hormone in polycystic ovarian disease.
        J. Clin. Endocrinol. Metab. 1970; 30: 435
        • Rebar R.
        • Judd H.L.
        • Yen S.S.C.
        • Rakoff J.
        • Vandenberg G.
        • Naftolin F.
        Characterization of the inappropriate gonadotropin secretion in polycystic ovary syndrome.
        J. Clin. Invest. 1976; 57: 1320
        • Givens J.R.
        • Andersen R.N.
        • Umstot E.S.
        • Wiser W.L.
        Clinical findings and hormonal responses in patients with polycystic ovarian disease with normal versus elevated LH levels.
        Obstet. Gynecol. 1976; 47: 388
        • Berger M.J.
        • Taymor M.L.
        • Patton W.C.
        Gonadotropin levels and secretory patterns in patients with typical and atypical polycystic ovarian disease.
        Fertil. Steril. 1975; 26: 619
        • Rosenfield R.L.
        • Jones T.
        • Dupon C.
        • Fang V.S.
        • Anderson W.A.
        Androgens and ovarian structure in constant oestrus.
        J. Endocrinol. 1975; 65: 283
        • Korth-Schutz S.
        • Leving L.S.
        • Merkatz I.R.
        • New M.I.
        An unusal case of Cushing's syndrome, hilus cell tumor and polycystic ovaries.
        J. Clin. Endocrinol. Metab. 1974; 38: 794
        • Imperato-McGinley J.
        • Peterson R.E.
        • Sturla E.
        • Dawood Y.
        • Bar R.S.
        Primary amenorrhea associated with hirsutism, acanthosis nigricans, dermoid cysts of the ovaries and a new type of insulin resistance.
        Am. J. Med. 1978; 85: 389
        • Kahn C.R.
        • Flier J.S.
        • Bar R.S.
        • Archer J.A.
        • Gorden P.
        • Martin M.M.
        • Roth J.
        The syndrome of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man.
        N. Engl. J. Med. 1976; 294: 739
        • Greenblatt R.B.
        • Dominguez C.J.
        • Mahesh V.B.
        Achard-Theirs syndrome.
        in: Greenblatt R.B. The Hirsute Woman. Charles C Thomas, Publisher, Springfield, Illinois1963: 251
        • Hoffman F.
        • Megr C.
        On the action of intraovarian injection of androgen on follicle and corpus luteum maturation in women.
        Geburtshilfe Frauenheilkd. 1965; 25 (In German): 1132
        • Dupon D.
        • Rosenfield R.L.
        • Cleary R.E.
        Sequential changes in total and free testosterone and androstenedione in plasma during spontaneous and Clomid-induced ovulatory cycles.
        Am. J. Obstet. Gynecol. 1973; 115: 473
        • Sherman B.M.
        • Korenman S.G.
        Measurement of serum LH, FSH, estradiol, and progesterone in disorders of the human menstrual cycle: The inadequate luteal phase.
        J. Clin. Endocrinol. Metab. 1974; 39: 145
        • Maroulis G.B.
        • Abraham G.E.
        Ovarian and adrenal contributions to peripheral steroid levels in postmenopausal women.
        Obstet. Gynecol. 1976; 48: 150
        • Braithwaite S.S.
        • Erkman-Balis B.
        • Avila T.D.
        Postmenopausal virilization due to ovarian stromal hyperthecosis.
        J. Clin. Endocrinol. Metab. 1978; 46: 295
        • MacRae D.J.
        • Willmott M.P.
        • Ismail A.A.A.
        • Love D.N.
        Androgen patterns in a case of hilar cell hyperplasia of the ovary.
        J. Obstet. Gynaecol. Br. Commonw. 1971; 78: 741
        • Judd H.L.
        • Benirschke K.
        • DeVane G.
        • Reuter S.R.
        • Yen S.S.C.
        Maternal virilization developing during a twin pregnancy. Demonstration of excess ovarian androgen production associated with theca lutein cysts.
        N. Engl. J. Med. 1973; 288: 118
        • Lee P.A.
        • Kowarski A.
        • Migeon C.J.
        • Blizzard R.M.
        Lack of correlation between gonadotropin and adrenal androgen levels in agonadal children.
        J. Clin. Endocrinol. Metab. 1975; 40: 664
        • Bergman P.
        • Sjogren B.
        • Hakansson B.
        Hypertensive form of congenital adrenocortical hyperplasia.
        Acta Endocrinol. 1962; 40: 555
        • Kase N.
        • Kowal J.
        • Perolff W.
        • Soffer L.J.
        In vitro production of androgens by a virilizing adrenal adenoma and associated polycystic ovaries.
        Acta Endocrinol. 1963; 44: 15
        • Maschler I.
        • Satzberger M.
        • Finkelstein M.
        11β-Hydroxylase with affinity to C-21-deoxysteroids from ovaries of patients with polycystic ovary syndrome.
        J. Clin. Endocrinol. Metab. 1975; 41: 999
        • Rosenfield R.L.
        • Bickel S.
        • Razdan A.K.
        Amenorrhea related to progestin excess in congenital adrenal hyperplasia.
        Obstet. Gynecol. 1980; 56: 208
        • Hosseinian A.H.
        • Kim M.H.
        • Rosenfield R.L.
        Obesity and oligomenorrhea are associated with hyperandrogenism independent of hirsutism.
        J. Clin. Endocrinol. Metab. 1976; 42: 765
        • Glass A.R.
        • Dahms W.T.
        • Abraham G.
        • Atkinson R.L.
        • Bray G.A.
        • Swerdloff R.S.
        Secondary amenorrhea in obesity: etiologic role of weight-related androgen excess.
        Fertil. Steril. 1978; 30: 243
        • O'Dea J.P.K.
        • Wieland R.G.
        • Hallberg M.C.
        • Llerena L.A.
        • Zorn E.M.
        • Genuth S.M.
        Effect of dietary weight loss on sex steroid binding, sex steroids, and gonadotropins in obese postmenopausal women.
        J. Lab. Clin. Med. 1979; 93: 1004
        • Meldrum D.R.
        • Abraham G.E.
        Peripheral and ovarian venous concentrations of various steroid hormones in virilizing ovarian tumors.
        Obstet. Gynecol. 1979; 53: 36
        • Lieberman L.M.
        • Beierwaltes W.H.
        • Conn J.W.
        • Ansari A.N.
        • Nishiyama H.
        Diagnosis of adrenal disease by visualization of human adrenal glands with 131I-19-iodocholesterol.
        N. Engl. J. Med. 1971; 285: 1387
        • Werk Jr., E.E.
        • Sholiton L.J.
        • Kalejs L.
        Testosterone-secreting adrenal adenoma under gonadotropin control.
        N. Engl. J. Med. 1973; 289: 767
        • Jones T.M.
        • Fang V.S.
        • Landau R.L.
        • Rosenfield R.
        Direct inhibition of Leydig cell function by estradiol.
        J. Clin. Endocrinol. Metab. 1978; 47: 1368
        • Tsang B.K.
        • Leung P.C.K.
        • Armstrong D.T.
        Inhibition of porcine thecal androgen production in vitro.
        Molec. Cell. Endocrinol. 1979; 14: 131
        • Tucci J.R.
        • Zah F.
        • Kalderon R.E.
        Endocrine studies in an arrhenoblastoma responsive to dexamethasone, ACTH and human chorionic gonadotropin.
        Am. J. Med. 1973; 55: 687
        • Easterling W.E.
        • Talbert L.M.
        • Potter H.D.
        Serum testosterone levels in the polycystic ovary syndrome.
        Am. J. Obstet. Gynecol. 1974; 120: 385
        • Drill V.A.
        Oral Contraceptives. McGraw-Hill Book Co., Inc, New York1966: 16 (chap. 2)
        • Gambrell Jr., R.D.
        • Greenblatt R.B.
        • Mahesh V.B.
        Post-pill and pill-related amenorrhea-galactorrhea.
        Am. J. Obstet. Gynecol. 1971; 110: 838
        • Halbert D.R.
        • Christian C.D.
        Amenorrhea following oral contraceptives.
        Obstet. Gynecol. 1969; 34: 161
        • de Oliveira R.F.C.
        • Novaes L.P.
        • Lima M.B.
        • Rodrigues J.
        • Granco S.
        • Khenaifes A.I.
        A new treatment for hirsutism.
        Ann. Intern. Med. 1975; 83: 817
        • Ettinger B.
        • Golditch I.M.
        Medroxyprogesterone acetate for the evaluation of hypertestosteronism in hirsute women.
        Fertil. Steril. 1977; 28: 1285
        • Stewart M.E.
        • Pochi P.E.
        Antiandrogens and the skin.
        Int. J. Dermatol. 1978; 17: 167
        • Girard J.
        • Baumann J.B.
        • Buhler U.
        • Zuppinger K.
        • Haas H.G.
        • Staub J.J.
        • Wyss H.I.
        Cyproteroneacetate and ACTH adrenal function.
        J. Clin. Endocrinol. Metab. 1978; 47: 581
        • Vigersky R.A.
        • Mehlman I.
        • Glass A.R.
        • Smith C.E.
        Treatment of hirsute women with cimetidine.
        N. Engl. J. Med. 1980; 303: 1042
        • Rust L.A.
        • Ismael R.
        • Mishell D.R.
        An individualized graduated therapeutic regimen for clomiphene citrate.
        Am. J. Obstet. Gynecol. 1974; 120: 785
        • Greenblatt R.B.
        Cortisone in treatment of the hirsute woman.
        Am. J. Obstet. Gynecol. 1953; 66: 700
        • Rodriguez-Rigau L.J.
        • Smith K.D.
        • Tcholakian R.K.
        • Steinberger E.
        Effects of prednisone on plasma testosterone levels and on duration of phases of the menstrual cycle in hyperandrogenic women.
        Fertil. Steril. 1979; 32: 408
        • Toaff R.
        • Toaff M.E.
        • Gould S.
        • Chayen R.
        Role of androgenic hyperactivity in ovulation.
        Fertil. Steril. 1978; 29: 407
        • Tredway D.R.
        • Goebelsmann U.
        • Thorneycroft I.H.
        • Mishell D.R.
        Monitoring induction of ovulation with human menopausal gonadotropin by a rapid estrogen radioimmunoassay.
        Am. J. Obstet. Gynecol. 1974; 120: 1035
        • Hammond C.B.
        • Wiebe R.H.
        • Haney A.R.
        • Yancy S.G.
        Ovulation induction with luteinizing hormone-releasing hormone in amenorrheic, infertile women.
        Am. J. Obstet. Gynecol. 1979; 135: 924
        • Givens J.R.
        • Andersen R.N.
        • Wiser W.L.
        • Fish S.A.
        Dynamics of suppression and recovery of plasma FSH, LH, androstenedione and testosterone in polycystic ovarian disease using an oral contraceptive.
        J. Clin. Endocrinol. Metab. 1974; 38: 727
        • Weinstein D.
        • Polishuk W.Z.
        The role of wedge resection of the ovary as a cause for mechanical sterility.
        Surg. Gynecol. Obstet. 1975; 141: 417

      Article Info

      Footnotes

      ☆Portions of this work were supported by United States Public Health Service Grant HD-06308, The Mother's Aid Research Foundation of the University of Chicago Lying-In-Hospital, and the Ford Foundation. Many of the studies reported here were carried out in the Clinical Research Center of the University of Chicago Hospitals, which are supported by United States Public Health Service Grants RR-305 and RR-55.

      Identification

      DOI: https://doi.org/10.1016/0002-9378(81)90746-8

      Copyright

      © 1981 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2022 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX