Abstract
To evaluate the effects of changing steroid milieu on adrenocortical function, basal levels and responses of cortisol, 17-hydroxyprogesterone (17PO), androstenedione (A), dehydroepiandrosterone (DHEA), and testosterone to exogenous synthetic ACTH were investigated in six normal women during the early follicular (EF) and midluteal (ML) phases of the menstrual cycle and in five women on an oral contraceptive (OC) agent (35 μg ethinyl estradiol and 1 mg ethynodiol diacetate, Demulen). Baseline serum steroid and cortisol binding globulin (CBG) levels were measured on days 3–7 and 21–23 of the menstrual cycle in the normal subjects and on days 3–7 of OC treatment cycles. ACTH stimulation (10μg m-2 i.v. bolus) was performed following dexamethasone suppression (0.5 mg p.o. q 6h×4). Basal levels of cortisol and CBG as well as cortisol responses to ACTH were increased in OC users relative to normal women tested during both the EF and ML phases of the cycle. In addition, 17PO levels were increased during the ML phase both before and following dexamethasone suppression compared to levels present in the EF phase and in OC users, no doubt because of increased ovarian steroidogenesis.
Resumé
Afin d'évaluer les effects d'un changement du milieu stéroïde sur la fonction cortico-surrénale, par l'introduction d'ACTH synthétique exogène, on a étudié les niveaux basals et les réponses de cortisol, le 17-hydroxyprogestérone (17PO), l'androsténédione (A), la dihydroépiandrostérone (DHEA) et la testostérone chez 6 femmes normales au tout début de la phase folliculinique (PF) et au milieu de la phase lutéinique (PL) du cycle menstruel, ainsi que chez 5 femmes sous traitement contraceptif oral (CO-35μg d'éthinyl oestradiol et 1 mg de diacétate d'éthynodiol, Demulen).
On a mesuré le niveau de base des stéroïdes du sérum et les niveaux des globulines agglutinantes du cortisol (CBG) aux jours 3 à 7 et 21 à 23 du cycle menstruel chez les femmes normales et aux jours 3 à 7 du cycle chez les femmes sous traitement (CO). La stimulation de l'ACTH (10 μg/m2, par voie I.V.) a été effectuée après suppression á la dexaméthasone (0,5 mg, per os 4 fois à intervalles de 6 heures). Les niveaux basals de cortisol et de CBG, ainsi que les résponses du cortisol à l'ACTH avaient augmenté chez les utilisatrices de CO en comparaison avec les femmes normales examinées pendant les phases FP et ML du cycle. En outre, les niveaux de 17PO étaient plus élevés pendant la phase ML, tant avant qu'après la suppression à la dexaméthasone en comparaison avec les niveaux présents pendant la phase folliculinique chez les utilisatrices de CO, ce qui était sans aucun doute dû à une stéroïdogenèse ovarienne accure.
Resumen
Se investigaron seis mujeres normales durante la fase folicular temprana (EF) y lútea media (ML) del ciclo menstrual y cinco mujeres usando anticonceptivos orales (OC) (etinilestradiol 35 μg y diacetato de etinodiol 1 mg, Demulen) a fin de evaluar los efectos de los cambios esteroidales en la función adrenocortical, sus niveles basales y las respuestas de cortisol, 17-hidroxiprogesterona (17PO), androstenediona (A), dehidroepiandrosterona (DHEA) y testosterona a la estimulación con ACTH sintético. Se midieron los niveles basales de esteroides séricos y de globulina ligante del cortisol (CBG) en los días 3–7 y 21–23 del ciclo menstrual en sujetos normales y en los días 3–7 del ciclo de tratamiento con anticonceptiovos orales. Se efectuó la estimulación con ACTH (10μg/m2 bolo EV) siguiendo a la supresión con dexametasona (0.5 mg po q 6h×4). Los niveles basales de cortisol y CBG asi como las respuestas del cortisol al ACTH aumentaron en las usuarias de anticonceptivos orales en relación con las mujeres normales analizadas durante ambas fases, EF y ML, del ciclo. Además, los niveles de 17-hidroxiprogesterona fueron incrementados durante la fase lútea media (ML) antes y luego de la supresión con dexametasona comparados a los niveles en la fase folicular temprana (EF) y en las usuarias de anticonceptivos orales, sin duda debido a un aumento en la esteroidogénesis ovárica.
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Supported in part by NIH HD-12303 and HD-19542 and the UCSD General Clinical Research Center NIH/Division of Research Resources (Grant RR-00827)
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Fujimoto, V.Y., Villanueva, A.L., Hopper, B. et al. Increased adrenocortical responsiveness to exogenous ACTH in oral contraceptive users. Adv Contracept 2, 343–353 (1986). https://doi.org/10.1007/BF02340051
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DOI: https://doi.org/10.1007/BF02340051