A pilot study of the human chorionic gonadotrophin test for ovarian hyperandrogenism

A controlled clinical study was designed to investigate the value of humanchorionic gonadotrophin (HCG) challenge as a test for functional ovarianhyperandrogenism. Dexamethasone administration was followed by 5000 IU HCGand blood samples for steroid hormone assay were obtained 0, 8, 16, and 24h thereafter. Study subjects were normal women (n = 13); women withfunctional ovarian hyperandrogenism, defined by androgen excess,amenorrhoea and an increased 17-hydroxyprogesterone response to nafarelin(n = 6); and normal men (n = 4). The responses of 17-hydroxyprogesterone,androstenedione and testosterone to HCG in women with functional ovarianhyperandrogenism were significantly greater than in normal women. However,the 17-hydroxyprogesterone response to HCG in functional ovarianhyperandrogenism was significantly lower after HCG than after nafarelin.The oestradiol response was also significantly lower after HCG thannafarelin, although oestradiol concentration more than doubled in normalwomen as well as in women with functional ovarian hyperandrogenism. Theresponses to HCG confirm that functional ovarian hyperandrogenismabnormalities are luteinizing hormone (LH)-dependent. Therefore, the 17-hydroxyprogesterone response to HCG could represent a useful test for thediagnosis of ovarian hyperandrogenism. The lower 17- hydroxyprogesteroneresponse to HCG than to nafarelin in functional ovarian hyperandrogenismsuggests that a follicle-stimulating hormone (FSH)-responsive factormodulates thecal 17-hydroxyprogesterone secretion. The oestradiol responseto HCG is consistent with HCG directly stimulating the oestradiol secretionby thecal cells.