The adrenal and polycystic ovary syndrome

Reviews in Endocrine and Metabolic Disorders

Volumn 8, Issue 4, 2007, Pages 331-342

  Yildiz, Bulent O ^a   Azziz, Ricardo ^b  

^a HACETTEPE UNIVERSITY   (Turkey)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Adrenal; Cortisol; DHEA; Heritability; Hyperandrogenism; PCOS

Indexed keywords

ANDROGEN; CORTICOTROPIN; GLUCOSE; HYDROCORTISONE; INSULIN; PRASTERONE SULFATE;

ADRENAL CORTEX INSUFFICIENCY; ADRENAL GLAND; ENZYME ACTIVATION; ENZYME SYNTHESIS; HERITABILITY; HUMAN; HYPERINSULINEMIA; HYPOTHALAMUS HYPOPHYSIS ADRENAL SYSTEM; INSULIN RESISTANCE; OBESITY; OVARY; OVARY POLYCYSTIC DISEASE; REVIEW; STEROID METABOLISM; STEROIDOGENESIS;

ADRENAL GLANDS; ADRENOCORTICOTROPIC HORMONE; ANDROGENS; FEMALE; HUMANS; HYDROCORTISONE; HYPERANDROGENISM; POLYCYSTIC OVARY SYNDROME;

EID: 38049054091     PISSN: 13899155     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11154-007-9054-0     Document Type: Review

References (106)

1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-9.
2. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005;352:1223-36.
3. Azziz R, Marin C, Hoq L, Badamgarav E, Song P. Healthcare-related economic burden of the polycystic ovary syndrome (PCOS) during the reproductive lifespan. J Clin Endocrinol Metab 2005;90:4650-8.
4. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome. In: Dunaif A, Givens J, Haseltine F, Merriam GR, editors. Polycystic ovary syndrome. Boston: Blackwell Scientific Publications; 1992. pp. 377-84.
5. The Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group: Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19-25.
6. The Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group: revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (pcos). Hum Reprod 2004;19:41-7.
7. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metab 2006;91:4237-45.
8. Gallagher TF, Kappas A, Hellman L, Lipsett MB, Pearson OH, West CD. Adrenocortical hyperfunction in idiopathic hirsutism and the stein-leventhal syndrome. J Clin Invest 1958;37:794-9.
9. Wild RA, Umstot ES, Andersen RN, Ranney GB, Givens JR. Androgen parameters and their correlation with body weight in one hundred thirty-eight women thought to have hyperandrogenism. Am J Obstet Gynecol 1983;146:602-6.
10. Hoffman DI, Klove K, Lobo RA. The prevalence and significance of elevated dehydroepiandrosterone sulfate levels in anovulatory women. Fertil Steril 1984;42:76-81.
11. Steinberger E, Smith KD, Rodriguez-Rigau LJ. Testosterone, dehydroepiandrosterone, and dehydroepiandrosterone sulfate in hyperandrogenic women. J Clin Endocrinol Metab 1984;59:471-7.
12. Carmina E, Rosato F, Janni A. Increased DHEAS levels in PCO syndrome: evidence for the existence of two subgroups of patients. J Endocrinol Invest 1986;9:5-9.
13. Price FV, Legro RS, Watt-Morse M, Kaplan SS. Chediak-Higashi syndrome in pregnancy. Obstet Gynecol 1992;79:804-6.
14. Levin JH, Carmina E, Lobo RA. Is the inappropriate gonadotropin secretion of patients with polycystic ovary syndrome similar to that of patients with adult-onset congenital adrenal hyperplasia? Fertil Steril 1991;56:635-40.
15. Carmina E, Lobo RA. Ovarian suppression reduces clinical and endocrine expression of late-onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Fertil Steril 1994;62:738-43.
16. Dewailly D, Vantyghem-Haudiquet MC, Sainsard C, Buvat J, Cappoen JP, Ardaens K, Racadot A, Lefebvre J, Fossati P. Clinical and biological phenotypes in late-onset 21-hydroxylase deficiency. J Clin Endocrinol Metab 1986;63:418-23.
17. Moran C, Azziz R, Carmina E, Dewailly D, Fruzzetti F, Ibanez L, Knochenhauer ES, Marcondes JA, Mendonca BB, Pignatelli D, Pugeat M, Rohmer V, Speiser PW, Witchel SF. 21-hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: a multicenter study. Am J Obstet Gynecol 2000;183:1468-74.
18. Lobo RA, Goebelsmann U, Horton R. Evidence for the importance of peripheral tissue events in the development of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 1983;57:393-7.
19. Ibanez L, Potau N, Virdis R, Zampolli M, Terzi C, Gussinye M, Carrascosa A, Vicens-Calvet E. Postpubertal outcome in girls diagnosed of premature pubarche during childhood: increased frequency of functional ovarian hyperandrogenism. J Clin Endocrinol Metab 1993;76:1599-603.
20. Miller D, Emans SJ, Kohane I. Follow-up study of adolescent girls with a history of premature pubarche. J Adolesc Health 1996;18:301-5.
21. Ibanez L, Potau N, Zampolli M, Street ME, Carrascosa A. Girls diagnosed with premature pubarche show an exaggerated ovarian androgen synthesis from the early stages of puberty: Evidence from gonadotropin-releasing hormone agonist testing. Fertil Steril 1997;67:849-55.
22. Meas T, Chevenne D, Thibaud E, Leger J, Cabrol S, Czernichow P, Levy-Marchal C. Endocrine consequences of premature pubarche in post-pubertal Caucasian girls. Clin Endocrinol (Oxf) 2002;57:101-6.
23. Witchel SF, Lee PA, Suda-Hartman M, Hoffman EP. Hyperandrogenism and manifesting heterozygotes for 21-hydroxylase deficiency. Biochem Mol Med 1997;62:151-8.
24. Witchel SF, Aston CE. The role of heterozygosity for CYP21 in the polycystic ovary syndrome. J Pediatr Endocrinol Metab 2000;13 Suppl 5:1315-17.
25. Ostlere LS, Rumsby G, Holownia P, Jacobs HS, Rustin MH, Honour JW. Carrier status for steroid 21-hydroxylase deficiency is only one factor in the variable phenotype of acne. Clin Endocrinol (Oxf) 1998;48:209-15.
26. Admoni O, Israel S, Lavi I, Gur M, Tenenbaum-Rakover Y. Hyperandrogenism in carriers of CYP21 mutations: the role of genotype. Clin Endocrinol (Oxf) 2006;64:645-51.
27. Witchel SF, Kahsar-Miller M, Aston CE, White C, Azziz R. Prevalence of CYP21 mutations and IRS1 variant among women with polycystic ovary syndrome and adrenal androgen excess. Fertil Steril 2005;83:371-5.
28. Moran C, Knochenhauer E, Boots LR, Azziz R. Adrenal androgen excess in hyperandrogenism: Relation to age and body mass. Fertil Steril 1999;71:671-4.
29. Guo Q, Kumar TR, Woodruff T, Hadsell LA, DeMayo FJ, Matzuk MM. Overexpression of mouse follistatin causes reproductive defects in transgenic mice. Mol Endocrinol 1998;12:96-106.
30. Azziz R, Koulianos G. Adrenal androgens and reproductive aging in females. Semin Reprod Endocrinol 1991;9:249-60.
31. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992;167:1807-12.
32. Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (pcos). Clin Endocrinol (Oxf) 2005;62:644-9.
33. Azziz R, Dewailly D, Owerbach D. Clinical review 56: nonclassic adrenal hyperplasia: current concepts. J Clin Endocrinol Metab 1994;78:810-15.
34. Derksen J, Nagesser SK, Meinders AE, Haak HR, van de Velde CJ. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med 1994;331:968-73.
35. Korth-Schutz S, Levine LS, New MI. Dehydroepiandrosterone sulfate (DS) levels, a rapid test for abnormal adrenal androgen secretion. J Clin Endocrinol Metab 1976;42:1005-1013.
36. Lobo RA, Paul WL, Goebelsmann U. Dehydroepiandrosterone sulfate as an indicator of adrenal androgen function. Obstet Gynecol 1981;57:69-73.
37. Yildiz B, Carmina E, Azziz R. Hypothalamic-pituitary-adrenal dysfunction in the polycystic ovary syndrome. In: Azziz R, Nestler J, Dewailly D, editors. Androgen excess disorders in women: Polycystic ovary syndrome and other disorders. Totowa, New Jersey: Humana Press; 2006. pp. 213-22.
38. Azziz R, Gay FL, Potter SR, Bradley E, Jr., Boots LR. The effects of prolonged hypertestosteronemia on adrenocortical biosynthesis in oophorectomized women. J Clin Endocrinol Metab 1991;72:1025-30.
39. Azziz R, Rittmaster RS, Fox LM, Bradley EL, Jr., Potter HD, Boots LR. Role of the ovary in the adrenal androgen excess of hyperandrogenic women. Fertil Steril 1998;69:851-9.
40. Hines GA, Azziz R. Impact of architectural disruption on adrenocortical steroidogenesis in vitro. J Clin Endocrinol Metab 1999;84:1017-21.
41. Hines GA, Smith ER, Azziz R. Influence of insulin and testosterone on adrenocortical steroidogenesis in vitro: preliminary studies. Fertil Steril 2001;76:730-5.
42. Huerta R, Dewailly D, Decanter C, Knochenhauer ES, Boots LR, Azziz R. 11beta-hydroxyandrostenedione and delta5-androstenediol as markers of adrenal androgen production in patients with 21-hydroxylase-deficient nonclassic adrenal hyperplasia. Fertil Steril 1999;72:996-1000.
43. Moran C, Reyna R, Boots LS, Azziz R. Adrenocortical hyperresponsiveness to corticotropin in polycystic ovary syndrome patients with adrenal androgen excess. Fertil Steril 2004;81:126-31.
44. Azziz R, Ehrmann DA, Legro RS, Fereshetian AG, O'Keefe M, Ghazzi MN. Troglitazone decreases adrenal androgen levels in women with polycystic ovary syndrome. Fertil Steril 2003;79:932-7.
45. Carmina E, Levin JH, Malizia G, Lobo RA. Ovine corticotropin-releasing factor and dexamethasone responses in hyperandrogenic women. Fertil Steril 1990;54:245-50.
46. Horrocks PM, Kandeel FR, London DR, Butt WR, Lynch SS, Holder G, Logan-Edwards R. Acth function in women with the polycystic ovarian syndrome. Clin Endocrinol (Oxf) 1983;19:143-50.
47. Carmina E, Lobo RA. Pituitary-adrenal responses to ovine corticotropin-releasing factor in polycystic ovary syndrome and in other hyperandrogenic patients. Gynecol Endocrinol 1990;4:225-32.
48. Azziz R, Black V, Hines GA, Fox LM, Boots LR. Adrenal androgen excess in the polycystic ovary syndrome: sensitivity and responsivity of the hypothalamic-pituitary-adrenal axis. J Clin Endocrinol Metab 1998;83:2317-23.
49. Azziz R, Wells G, Zacur HA, Acton RT. Abnormalities of 21-hydroxylase gene ratio and adrenal steroidogenesis in hyperandrogenic women with an exaggerated 17-hydroxyprogesterone response to acute adrenal stimulation. J Clin Endocrinol Metab 1991;73:1327-31.
50. Azziz R, Owerbach D. Molecular abnormalities of the 21-hydroxylase gene in hyperandrogenic women with an exaggerated 17-hydroxyprogesterone response to short-term adrenal stimulation. Am J Obstet Gynecol 1995;172:914-8.
51. Joehrer K, Geley S, Strasser-Wozak EM, Azziz R, Wollmann HA, Schmitt K, Kofler R, White PC. CYP11B1 mutations causing non-classic adrenal hyperplasia due to 11 beta-hydroxylase deficiency. Hum Mol Genet 1997;6:1829-34.
52. Lutfallah C, Wang W, Mason JI, Chang YT, Haider A, Rich B, Castro-Magana M, Copeland KC, David R, Pang S. Newly proposed hormonal criteria via genotypic proof for type 2 3beta-hydroxysteroid dehydrogenase deficiency. J Clin Endocrinol Metab 2002;87:2611-22.
53. Carbunaru G, Prasad P, Scoccia B, Shea P, Hopwood N, Ziai F, Chang YT, Myers SE, Mason JI, Pang S. The hormonal phenotype of nonclassic 3 beta-hydroxysteroid dehydrogenase (HSD3B) deficiency in hyperandrogenic females is associated with insulin-resistant polycystic ovary syndrome and is not a variant of inherited HSD3B2 deficiency. J Clin Endocrinol Metab 2004;89:783-94.
54. Kahsar-Miller M, Boots LR, Bartolucci A, Azziz R. Role of a CYP17 polymorphism in the regulation of circulating dehydroepiandrosterone sulfate levels in women with polycystic ovary syndrome. Fertil Steril 2004;82:973-5.
55. Prelevic GM, Wurzburger MI, Balint-Peric L. 24-hour serum cortisol profiles in women with polycystic ovary syndrome. Gynecol Endocrinol 1993;7:179-84.
56. Vogeser M, Halser B, Baron A, Jacob K, Demant T. Corticosteroid-binding globulin and unbound serum cortisol in women with polycystic ovary syndrome. Clin Biochem 2000;33:157-9.
57. Stewart PM, Penn R, Holder R, Parton A, Ratcliffe JG, London DR. The hypothalamo-pituitary-adrenal axis across the normal menstrual cycle and in polycystic ovary syndrome. Clin Endocrinol (Oxf) 1993;38:387-91.
58. Invitti C, Pecori Giraldi F, Dubini A, De Martin M, Cavagnini F. Increased urinary free cortisol and decreased serum corticosteroid-binding globulin in polycystic ovary syndrome. Acta Endocrinol (Copenh) 1991;125:28-32.
59. Walker BR, Rodin A, Taylor NF, Clayton RN. Endogenous inhibitors of 11beta-hydroxysteroid dehydrogenase type 1 do not explain abnormal cortisol metabolism in polycystic ovary syndrome. Clin Endocrinol (Oxf) 2000;52:77-80.
60. Stewart PM, Shackleton CH, Beastall GH, Edwards CR. 5 alpha-reductase activity in polycystic ovary syndrome. Lancet 1990;335:431-3.
61. Tsilchorozidou T, Honour JW, Conway GS. Altered cortisol metabolism in polycystic ovary syndrome: insulin enhances 5alpha-reduction but not the elevated adrenal steroid production rates. J Clin Endocrinol Metab 2003;88:5907-13.
62. Fassnacht M, Schlenz N, Schneider SB, Wudy SA, Allolio B, Arlt W. Beyond adrenal and ovarian androgen generation: increased peripheral 5 alpha-reductase activity in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:2760-66.
63. Chin D, Shackleton C, Prasad VK, Kohn B, David R, Imperato-McGinley J, Cohen H, McMahon DJ, Oberfield SE. Increased 5alpha-reductase and normal 11beta-hydroxysteroid dehydrogenase metabolism of C19 and C21 steroids in a young population with polycystic ovarian syndrome. J Pediatr Endocrinol Metab 2000;13:253-9.
64. Rodin A, Thakkar H, Taylor N, Clayton R. Hyperandrogenism in polycystic ovary syndrome. Evidence of dysregulation of 11 beta-hydroxysteroid dehydrogenase. N Engl J Med 1994;330:460-5.
65. Gonzalez F, Hatala DA, Speroff L. Adrenal and ovarian steroid hormone responses to gonadotropin-releasing hormone agonist treatment in polycystic ovary syndrome. Am J Obstet Gynecol 1991;165:535-45.
66. Rittmaster RS, Thompson DL. Effect of leuprolide and dexamethasone on hair growth and hormone levels in hirsute women: the relative importance of the ovary and the adrenal in the pathogenesis of hirsutism. J Clin Endocrinol Metab 1990;70:1096-102.
67. Cedars MI, Steingold KA, de Ziegler D, Lapolt PS, Chang RJ, Judd HL. Long-term administration of gonadotropin-releasing hormone agonist and dexamethasone: assessment of the adrenal role in ovarian dysfunction. Fertil Steril 1992;57:495-500.
68. Slayden SM, Crabbe L, Bae S, Potter HD, Azziz R, Parker CR, Jr. The effect of 17 beta-estradiol on adrenocortical sensitivity, responsiveness, and steroidogenesis in postmenopausal women. J Clin Endocrinol Metab 1998;83:519-24.
69. Marin CM, Bartolucci A, Azziz R. Prevalence of insulin resistance in polycystic ovary syndrome (PCOS) patients using the homeostatic measurement assessment (HOMA-IR). Fertil Steril 2003;80:274-5.
70. Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab 1999;84:165-9.
71. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev 1997;18:774-800.
72. Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW, Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986;62:904-10.
73. Nestler JE, Clore JN, Strauss JF, 3rd, Blackard WG. The effects of hyperinsulinemia on serum testosterone, progesterone, dehydroepiandrosterone sulfate, and cortisol levels in normal women and in a woman with hyperandrogenism, insulin resistance, and acanthosis nigricans. J Clin Endocrinol Metab 1987;64:180-4.
74. Kumar A, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS) using age-specific dheas levels adjusted for body mass and ethnicity. Fertil Steril 2003;80:46.
75. Kauffman RP, Baker VM, DiMarino P, Castracane VD. Hyperinsulinemia and circulating dehydroepiandrosterone sulfate in white and Mexican American women with polycystic ovary syndrome. Fertil Steril 2006;85:1010-16.
76. Falcone T, Finegood DT, Fantus IG, Morris D. Androgen response to endogenous insulin secretion during the frequently sampled intravenous glucose tolerance test in normal and hyperandrogenic women. J Clin Endocrinol Metab 1990;71:1653-7.
77. Farah-Eways L, Reyna R, Knochenhauer ES, Bartolucci AA, Azziz R. Glucose action and adrenocortical biosynthesis in women with polycystic ovary syndrome. Fertil Steril 2004;81:120-5.
78. Guido M, Romualdi D, Suriano R, Giuliani M, Costantini B, Apa R, Lanzone A. Effect of pioglitazone treatment on the adrenal androgen response to corticotrophin in obese patients with polycystic ovary syndrome. Hum Reprod 2004;19:534-9.
79. Arlt W, Auchus RJ, Miller WL. Thiazolidinediones but not metformin directly inhibit the steroidogenic enzymes p450c17 and 3beta-hydroxysteroid dehydrogenase. J Biol Chem 2001;276:16767-71.
80. la Marca A, Morgante G, Paglia T, Ciotta L, Cianci A, De Leo V. Effects of metformin on adrenal steroidogenesis in women with polycystic ovary syndrome. Fertil Steril 1999;72:985-9.
81. Arslanian SA, Lewy V, Danadian K, Saad R. Metformin therapy in obese adolescents with polycystic ovary syndrome and impaired glucose tolerance: amelioration of exaggerated adrenal response to adrenocorticotropin with reduction of insulinemia/insulin resistance. J Clin Endocrinol Metab 2002;87:1555-9.
82. Ehrhart-Bornstein M, Hinson JP, Bornstein SR, Scherbaum WA, Vinson GP. Intraadrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev 1998;19:101-43.
83. Forney JP, Milewich L, Chen GT, Garlock JL, Schwarz BE, Edman CD, MacDonald PC. Aromatization of androstenedione to estrone by human adipose tissue in vitro. Correlation with adipose tissue mass, age, and endometrial neoplasia. J Clin Endocrinol Metab 1981;53:192-9.
84. Ackerman GE, Smith ME, Mendelson CR, MacDonald PC, Simpson ER. Aromatization of androstenedione by human adipose tissue stromal cells in monolayer culture. J Clin Endocrinol Metab 1981;53:412-17.
85. Bulun SE, Simpson ER. Competitive reverse transcription-polymerase chain reaction analysis indicates that levels of aromatase cytochrome p450 transcripts in adipose tissue of buttocks, thighs, and abdomen of women increase with advancing age. J Clin Endocrinol Metab 1994;78:428-32.
86. Azziz R, Zacur HA, Parker CR, Jr., Bradley EL, Jr., Boots LR. Effect of obesity on the response to acute adrenocorticotropin stimulation in eumenorrheic women. Fertil Steril 1991;56:427-33.
87. Brody S, Carlstrom K, Lagrelius A, Lunell NO, Mollerstrom G. Adrenal steroids in post-menopausal women: relation to obesity and to bone mineral content. Maturitas 1987;9:25-32.
88. Komindr S, Kurtz BR, Stevens MD, Karas JG, Bittle JB, Givens JR. Relative sensitivity and responsivity of serum cortisol and two adrenal androgens to alpha-adrenocorticotropin-(1-24) in normal and obese, nonhirsute, eumenorrheic women. J Clin Endocrinol Metab 1986;63:860-4.
89. Vicennati V, Calzoni F, Gambineri A, Gagliardi L, Morselli Labate AM, Casimirri F, Pasquali R. Secretion of major adrenal androgens following acth administration in obese women with different body fat distribution. Horm Metab Res 1998;30:133-6.
90. Rittmaster RS, Deshwal N, Lehman L. The role of adrenal hyperandrogenism, insulin resistance, and obesity in the pathogenesis of polycystic ovarian syndrome. J Clin Endocrinol Metab 1993;76:1295-300.
91. Stewart PM, Boulton A, Kumar S, Clark PM, Shackleton CH. Cortisol metabolism in human obesity: impaired cortisone→cortisol conversion in subjects with central adiposity. J Clin Endocrinol Metab 1999;84:1022-7.
92. Vicennati V, Pasquali R. Abnormalities of the hypothalamic-pituitary- adrenal axis in nondepressed women with abdominal obesity and relations with insulin resistance: evidence for a central and a peripheral alteration. J Clin Endocrinol Metab 2000;85:4093-8.
93. Akamine Y, Kato K, Ibayashi H. Studies on changes in the concentration of serum adrenal androgens in pubertal twins. Acta Endocrinol (Copenh) 1980;93:356-64.
94. Rotter JI, Wong FL, Lifrak ET, Parker LN. A genetic component to the variation of dehydroepiandrosterone sulfate. Metabolism 1985;34:731-6.
95. Meikle AW, Stringham JD, Woodward MG, Bishop DT. Heritability of variation of plasma cortisol levels. Metabolism 1988;37:514-7.
96. Rice T, Sprecher DL, Borecki IB, Mitchell LE, Laskarzewski PM, Rao DC. The Cincinnati myocardial infarction and hormone family study: family resemblance for dehydroepiandrosterone sulfate in control and myocardial infarction families. Metabolism 1993;42:1284-90.
97. Azziz R, Fox LM, Zacur HA, Parker CR, Jr., Boots LR. Adrenocortical secretion of dehydroepiandrosterone in healthy women: highly variable response to adrenocorticotropin. J Clin Endocrinol Metab 2001;86:2513-7.
98. Thomas G, Frenoy N, Legrain S, Sebag-Lanoe R, Baulieu EE, Debuire B. Serum dehydroepiandrosterone sulfate levels as an individual marker. J Clin Endocrinol Metab 1994;79:1273-6.
99. Nafziger AN, Bowlin SJ, Jenkins PL, Pearson TA. Longitudinal changes in dehydroepiandrosterone concentrations in men and women. J Lab Clin Med 1998;131:316-23.
100. Yildiz BO, Woods KS, Stanczyk F, Bartolucci A, Azziz R. Stability of adrenocortical steroidogenesis over time in healthy women and women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004;89:5558-62.
101. Legro RS, Kunselman AR, Demers L, Wang SC, Bentley-Lewis R, Dunaif A. Elevated dehydroepiandrosterone sulfate levels as the reproductive phenotype in the brothers of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2002;87:2134-8.
102. Yildiz BO, Goodarzi MO, Guo X, Rotter JI, Azziz R. Heritability of dehydroepiandrosterone sulfate in women with polycystic ovary syndrome and their sisters. Fertil Steril 2006;86:1688-93.
103. Goodarzi MO, Guo X, Yildiz BO, Stanczyk FZ, Azziz R. Correlation of adrenocorticotropin steroid levels between women with polycystic ovary syndrome and their sisters. Am J Obstet Gynecol 2007;196:398 e391-5; discussion 398 e395-6.
104. Kahsar-Miller M, Azziz R, Feingold E, Witchel SF. A variant of the glucocorticoid receptor gene is not associated with adrenal androgen excess in women with polycystic ovary syndrome. Fertil Steril 2000;74:1237-40.
105. Dolzan V, Prezelj J, Vidan-Jeras B, Breskvar K. Adrenal 21-hydroxylase gene mutations in Slovenian hyperandrogenic women: evaluation of corticotrophin stimulation and hla polymorphisms in screening for carrier status. Eur J Endocrinol 1999;141:132-9.
106. Goodarzi MO, Antoine HJ, Azziz R. Genes for enzymes regulating dhea sulfonation are associated with levels of dhea-sulfate in polycystic ovary syndrome. J Clin Endocrinol Metab 2007;92:2659-64.