Body composition determined by dual energy x-ray absorptiometry and the abdominal visceral fat component determined by computed tomographic scanning were examined in women with Cushing's disease and compared with those in obese women with the same anthropometric parameters and those in nonobese women. Patients with Cushing's had no increase in total body fat or the trunk region (android) component, but had a higher intraabdominal fat area compared to the obese subjects. The total lean tissue mass was slightly reduced in Cushing's compared to that in the obese subjects due to a significant decrease in the muscle of the legs and arms; the reduced amounts of fat and lean tissue masses in the arms were the most significant findings in hypercortisolism. The body mineral and bone calcium contents were slightly reduced in Cushing's compared to those in the obese controls. Thus, although obese subjects had more fat and lean tissue and mineral masses than their normal weight counterparts, the Cushing's patients, with the same total fat mass and its components (except in the arms) as obese individuals, present total lean tissue and fractions, including body mineral and bone calcium contents, similar to those in nonobese subjects due to the depletion of the protein depots, as seen in hypercortisolism.

To determine the source(s) of the excessive androgen production in patients with the polycystic ovary syndrome (PCOS), 12 hirsute women with PCOS underwent selective left adrenal and left ovarian venous catheterization. Blood samples were collected simultaneously for determination of cortisol, 17-hydroxy-progesterone, androstenedione (delta), testosterone (T), dehydroepiandrosterone, and dehydroepiandrosterone sulfate. The relative contributions of adrenal secretion rates of T and delta in each patient were estimated by relating their adrenal gradients to those of cortisol. From such calculations we found that in all patients the major source of androgens was the ovary (direct ovarian secretion and/or ovarian secretion of prehormones which then were converted to androgen in the peripheral circulation). After catheterization, 11 of the 12 patients underwent a 5-day dexamethasone suppression test (2 mg/day). In 7 patients studied, plasma delta and/or T levels decreased significantly. Our results indicate that in hirsutism associated with the PCOS, the predominant source of androgens is the ovaries and that glucocorticoid suppression cannot assign adrenal origin as the site of excessive androgens.

Summary:Virilization in women is occasionally caused by ovarian stromal hyperthecosis. Although three cases of post-menopausal women with hyperthecosis have been reported, the history in two of them strongly suggests a premenopausal origin. We describe a 64 year old woman with postmenopausal virilization due to bilateral ovarian stromal hyperthecosis.

To evaluate the circadian rhythms of plasma androstenedione (delta) and testosterone (T), we used continuous blood withdrawal at 30-min intervals for 24 h to obtain integrated concentrations in six normal men. The data were submitted to contrast analysis as well as to a graphical method with smoothing of the variations between samples. As reference, cortisol (F) levels also were measured, since they have a well defined circadian rhythm. Integrated F concentrations had a circadian rhythm, with the highest levels between 0500 and 0900 h, nadir values between 2000 and 300 h, and secretory peaks coincident with lunch and dinner hours, suggesting the influence of food ingestion on secretion. Integrated androstenedione concentrations also had a circadian rhythm, with the highest levels between 0530 and 0930 h and the lowest between 1900 and 0230 h. There also were peaks with lunch and dinner, however, occurring some minutes before the corresponding ones for F. Integrated T concentrations had a circadian rhythm, with the peak values between 0100 and 1130 h and the lowest levels between 0700 and 2100 h. There were no peaks of the T integrated concentrations during the meal periods as found with F and delta. Furthermore, no correlation was found between the integrated concentrations of T and F or delta.