Adrenal and ovarian vein androgen levels and laparoscopic findings in hirsute women

Hirsute women pose a diagnostic dilemma when urinary 17 ketosteroid and serum testosterone levels are normal. To locate the site of androgen excess in 19 hirsute women, blood samples were collected from the left ovarian and adrenal veins via a catheter inserted into the right femoral vein. Laparoscopy and bilateral ovarian biopsies were also performed in 18 of the 19 patients studied. Nine women had elevated 17 ketosteroid (5 patients) and/or antecubital serum testosterone (5 patients) levels. Fourteen women had elevated testosterone concentrations distributed as follows: ovarian vein (6), adrenal vein (1), adrenal and ovarian veins (7). Androstenedione was elevated in the ovarian vein (7) and both adrenal and ovarian veins (11) in 18 patients. Laparoscopic examination revealed that less than 50% of the enlarged ovaries could be detected by pelvic examination. Histologic studies suggested that these patients comprised two groups: a group (6 patients) who appeared to ovulate and a group (12 patients) who lacked evidence of ovulation.