Secretion of C19-Steroids and Oestrogens in the Polycystic Ovary Syndrome. Ovarian Studies in Vivo and in Vitro (Including Studies in Vitro on a Coincidental Granulosa Cell Tumour)

SUMMARY Ovarian metabolism of C 19 -steroids and oestrogens has been assessed at ovarian wedge resection in 22 patients with polycystic ovaries. There were marked variations between different patients. High concentrations of androstenedione were found in ovarian vein plasma in some patients, and always after stimulation with human pituitary follicle-stimulating hormone (HP-FSH) in vivo . Its contribution to the daily production of testosterone has been considered. No measurable amounts of testosterone or dehydroepiandrosterone were found. Oestradiol concentration was sometimes normal or above. Large amounts of androstenedione were generally isolated from cyst fluid. Occasionally testosterone was found and also epitestosterone after FSH. That concentrations of oestrogens in cyst fluid are low was confirmed, but sometimes higher levels were found after FSH. Slices of ovarian tissue generally converted progesterone or pregnenolone to androstenedione in high yield but conversion to oestrogen appeared to be low. However, the difficulty of making quantitative comparisons by this method, in the absence of knowledge of the sizes of the pools of endogenous steroids in the tissue, has been recognized. No evidence was found in any of the 18 cases examined for a lack of 3β-hydroxysteroid dehydrogenase. In vitro synthesis of epitestosterone by both normal and polycystic ovaries has been observed. A coincidental granulosa cell tumour in one patient synthesized testosterone in high yield.