Introduction: Cushings disease (CD) is a condition due to an ACTH-secreting pituitary adenoma and leading to hypercorticism. Hirsutism is common in CD but its exact frequency has been poorly studied. It results from the stimulating effect of ACTH on adrenal production of androgens.
The aim of this study is to determine the androgenic profile in hirsute patients with CD.
Patients and methods: It is a retrospective study of nine female patients having a CD with hirsutism. Positive diagnosis of CD was made in the association of an ACTH-dependant hypercorticism, with a positive response to the high-dose-dexamethasone-suppressing test, and a pituitary adenoma on MRI.
Testosterone and DHEAS assays were carried out in all patients and δ-4-androstenedione assay was performed in five of them.
Results: Mean age at diagnosis was 32 (ext: 2445). Hirsutism was severe in at least three patients. Menstrual irregularities were present in six of the nine patients and minor signs of hyperandrogenia (seborrhoea, acne) in two of them. Pituitary adenoma was a macroadenoma in 5/9 cases. ACTH was elevated in all patients with a mean ACTH value at 113.4 pg/ml (ext: 65184). Mean values of testosterone, DHEAS and δ-4-androstenedione were respectively: 2.56 nmol/l (ext:1.43.3), 461 ng/ml (ext: 125821) and 348 ng/ml (ext: 219487). Six patients had a concomitant elevation of at least two androgens. Both testosterone and DHEAS were elevated in these six patients and δ-4-androstenedione was elevated in three of them. Only one patient had normal rates of testosterone and DHEAS.
Conclusion: Androgens are almost consistently mildly elevated in patients with CD and hirsutism. All hirsute patients with CD have an elevated ACTH, the majority of them has a pituitary macroadenoma. Further studies comparing these parameters in a larger cohort of patients having a CD, with and without hirsutism and hyperandrogenia, would be more conclusive.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.