The long term effects of nightly
dexamethasone administration on basal levels and diurnal fluctuations of circulating
gonadotropins,
androgens, and
cortisol were studied by frequent sampling in four women with polycystic
ovarian disease and a similar number of normal women. Basal LH,
testosterone, and
androstenedione levels were elevated in the patients with polycystic
ovarian disease. There were significant diurnal variations of all
steroids measured in both groups, with the exception of
androstenedione and
androstenediol in the polycystic
ovarian disease and control subjects, respectively. Nightly
dexamethasone administration for 1 month resulted in marked suppression of
dehydroepiandrosterone,
androstenediol, and
cortisol. For
testosterone the mean percent decreases of the 24-h transverse means were 15% and 46% for the polycystic
ovarian disease and normal subjects, respectively. For
androstenedione the mean percent decreases were only 7% and 20%, respectively. The diurnal variation of all
steroids disappeared with
dexamethasone. These results support the concept that in patients with polycystic
ovarian disease the majority of delta 5-androgens is adrenal while the preponderance of elevated
testosterone and
androstenedione is ovarian in origin. These results do not support the use of long term
dexamethasone as an effective agent in suppressing the elevated levels of
testosterone and
androstenedione in patients with this disease.