The aim of the study was to evaluate the hormonal (focusing on the urinary
steroid profile) and clinical effects of chronic
gonadotropin-releasing hormone (
GnRH) agonist treatment in patients with
polycystic ovary syndrome (PCOS) suffering from
hirsutism. A long-acting
GnRH agonist was administered for 6 months in eight PCOS patients. Hormonal effects were measured by determining serum
luteinizing hormone (LH),
follicle stimulating hormone (FSH),
prolactin,
testosterone and
estradiol concentrations, and by profiling urinary
steroids using capillary gas chromatography of 24-hour urine samples. To evaluate
5 alpha-reductase enzyme activity, the ratios of
androsterone to
etiocholanolone and 5 alpha-
tetrahydrocortisol to
tetrahydrocortisol were calculated in urine samples. The ratio of
androgen to
cortisol metabolites was also determined before, and 3 and 6 months after
therapy. LH and
estradiol levels were suppressed significantly after the first injection and
testosterone after the second injection of the
GnRH agonist. Thus, serum
testosterone was normalized. Ratios of urinary
steroids reflecting
5 alpha-reductase enzyme activity (
androsterone to
etiocholanolone and 5 alpha-
tetrahydrocortisol to
tetrahydrocortisol) and the ratio of
androgen to
cortisol metabolites decreased significantly after 3 months of treatment. Degree of
hirsutism, assessed by Ferriman-Gallwey score, diminished after 6 months, but not significantly. In conclusion, our data show that long-acting
GnRH agonist treatment of PCOS patients is effective in reducing serum and urinary
androgen levels, but it is not accompanied by an effective reduction in
hirsutism during a 6-month treatment period. A longer or a combined treatment would be needed to achieve significant improvement in
hirsutism. Gas chromatographic profiling of urinary
steroids and the use of specific ratios of the excreted metabolites seems to be a sensitive tool both in the diagnosis of PCOS and in monitoring ovarian suppression.