How common are polycystic ovaries and the polycystic ovarian syndrome in women with Cushing's syndrome?

• Published in: Clinical endocrinology (Oxford) 2000-10, Vol.53 (4), p.493-500
• Main Authors: Kaltsas, G. A., Korbonits, M., Isidori, A. M., Webb, J. A. W., Trainer, P. J., Monson, J. P., Besser, G. M., Grossman, A. B.
• Format: Article
• Language: English
• Subjects: Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Androgens - blood; Biological and medical sciences; Cushing Syndrome - blood; Cushing Syndrome - complications; Cushing Syndrome - diagnostic imaging; Endocrinopathies; Estrogens - blood; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hydrocortisone - blood; Magnetic Resonance Imaging; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Ovary - diagnostic imaging; Pituitary Function Tests; Pituitary Gland - pathology; Polycystic Ovary Syndrome - blood; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - diagnostic imaging; Prospective Studies; Tumors; Ultrasonography
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1046/j.1365-2265.2000.01117.x

OBJECTIVE Women with Cushing's syndrome (CS) may present with menstrual irregularity and symptoms/signs of hyperandrogenism, a phenotype similar to that of the polycystic ovarian syndrome (PCOS); however, currently there are no data on the prevalence of either polycystic ovaries (PCO) and/or PCOS in patients with CS. The aim of this study was to investigate their presence among women of reproductive age presenting with CS by analysing clinical, endocrinological and ultrasonographic features. DESIGN Prospective study of all women within the reproductive age (range 18–40 years) who presented with CS between August 1994 and January 2000. SUBJECTS AND METHODS Thirteen women (median age 32 years, range 18–39 years) with CS were evaluated. The diagnosis of CS was based on the presence of appropriate clinical features and an elevated serum midnight cortisol with failure to suppress 0900 hours serum cortisol to less than 50 nmol/l following a formal low‐dose dexamethasone suppression test (LDDST). All women had their clinical features relevant to possible hyperandrogenism, menstrual disorder and infertility recorded, and circulating gonadotrophins, oestradiol, androgens and SHBG levels measured; ovarian ultrasonography was performed during their initial assessment. Relevant MR/CT imaging of the pituitary and/or adrenal glands was performed. RESULTS Eleven women had ACTH‐dependent CS [nine Cushing's disease (CD), one ectopic ACTH syndrome due to a bronchial carcinoid, one periodic CS of unknown origin); two patients had ACTH‐independent CS (adrenal adenomas). All women with CS had at least one symptom/sign of hyperandrogenism (13 hirsutism, seven acne, five male‐pattern alopecia). Nine women (70%) had menstrual disturbances (four oligomenorrhoea, four amenorrhoea, one polymenorrhoea) while four women (30%) had a normal menstrual pattern. Serum oestradiol levels for the group as a whole were similar to those observed in the early follicular phase of normally menstruating women; however, seven women had low oestradiol, LH and FSH levels suggestive of hypogonadotrophic hypogonadism. Serum androgen levels (testosterone, androstendione and DHEAS), even in the presence of symptoms/signs of hyperandrogenism, were within the normal reference range but SHBG levels were uniformly decreased even in women with normal menstrual cycles. There was a negative correlation between urinary free cortisol, but not mean serum cortisol, and serum oestradiol, testosterone and SHBG levels