Assessment of clinical hyperandrogenism in adolescent girls

Hirsutism, oligomenorrhea, or amenorrhea are possible manifestations of excessive androgen production. Distinguishing between adrenal and ovarian causes of hyperandrogenism may be difficult, but is important to determine appropriate therapeutic intervention. We studied 21 adolescent girls referred with either hirsutism, menstrual irregularities, or both to determine if clinical features, basal steroid levels, or basal gonadotropin levels are useful in differentiating patients with mild errors in steroidogenesis, defined by ACTH stimulation tests, from those with other causes of hyperandrogenism. Progesterone, 17-hydroxypregnenolone, 17- hydroxyprogesterone, DHEA, androstenedione, and cortisol were measured prior to and 30 minutes after an intravenous bolus of Cortrosyn(R). The patients were divided into five groups based on their responses to ACTH: patients with decreased 21-hydroxylase activity, with decreased 3β-hydroxysteroid dehydrogenase activity, with other causes of hyperandrogenism, with no hormonal evidence of hyperandrogenism, and those with an indeterminate response. Eight of 21 (40%) adolescent girls were found to have responses consistent with mild errors in steroidogenesis. Neither clinical findings nor basal hormone levels distinguished these eight individuals from the other patients. We found ACTH stimulation tests to be most helpful in differentiating patients with mild errors in steroidogenesis from those with other causes of hyperandrogenism.