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Ovarian Steroidogenic Abnormalities in the Polycystic Ovary Syndrome

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Androgen Excess Disorders in Women

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Excess androgen biosynthesis is a diagnostic feature of polycystic ovary syndrome. The excess circulating androstenedione and testosterone is produced primarily by the ovary. The ovarian theca cells, the site of de novo androgen biosynthesis, are increased in number in polycystic ovaries, and they have increased steroidogenic capacity. The increase in steroidogenic capacity is caused by overexpression of steroidogenic enzymes because of increased transcription and mRNA stability. Primary factors in the hyperstimulation of thecal androgen production appear to be increased luteinizing hormone (LH) concentrations in some women and elevated insulin concentrations secondary to insulin resistance. Additional contributions may be made by other intraovarian factors that can augment the stimulatory effects of LH on thecal androgen biosynthesis.

The granulosa cells in arrested follicles in polycystic ovaries fail to increase the expression of aromatase, causing markedly decreased estrogen secretion. They also express higher concentrations of 5α-reductase enzymes, leading to the production of 5α-androstane-3,17-dione, a competitive inhibitor of aromatase activity. The granulosa cells prematurely express the cholesterol side-chain cleavage enzyme and LH receptors, hence they are overresponsive to LH and produce increased amounts of progesterone compared to granulosa cells from follicles at a similar developmental stage in regularly cycling control women. Thus, polycystic ovaries produce increased concentrations of androgens and progesterone, decreased concentrations of estrogens, and abnormally high concentrations of 5α-reduced androgens, compared to normal ovaries.

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Authors and Affiliations

    Authors
    1. Denis A. Magoffin
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    Editors and Affiliations

    1. Center for Androgen Related Disorders, Cedars-Sinai Medical Center; and Department of Obstetrics and Gynecology, and Department of Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, CA

      Ricardo Azziz MD, MPH, MBA

    2. Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA

      John E. Nestler MD

    3. Department of Endocrine Gynaecology and Reproductive Medicine, Lille University Hospital, Lille, France

      Didier Dewailly MD

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    © 2006 Humana Press Inc., Totowa, NJ

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    Magoffin, D.A. (2006). Ovarian Steroidogenic Abnormalities in the Polycystic Ovary Syndrome. In: Azziz, R., Nestler, J.E., Dewailly, D. (eds) Androgen Excess Disorders in Women. Contemporary Endocrinology. Humana Press. https://doi.org/10.1007/978-1-59745-179-6_18

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    • DOI: https://doi.org/10.1007/978-1-59745-179-6_18

    • Publisher Name: Humana Press

    • Print ISBN: 978-1-58829-663-4

    • Online ISBN: 978-1-59745-179-6

    • eBook Packages: MedicineMedicine (R0)

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