We investigated the relation between the androgens and adrenal gland volume (AV), which has been suggested as an indicator of corticotropin, related adrenal activity, in 29 hirsute women without polycystic ovary syndrome and 11 healthy women. Three of the hirsute women were diagnosed as non classic congenital adrenal hyperplasia (NCAH). The rest twenty-six hirsute women had normal plasma androgen levels and formed the normo-androgenic hirsute (NAH) group (considered as idiopathic hirsutism). Dehydroepiandrosterone sulfate (DHEAS), 17-alpha-hydroxyprogesterone (17_OHP), testosterone (Test), free testosterone (FTest), cortisol and aldosterone levels were measured and spiral examinations of the adrenal glands with computed tomography (CT) were performed. Subjects with larger adrenal glands (eight women with total AV >= 7.5 ml) had higher mean plasma DHEAS and 17_OHP levels than the rest thirty-two patients with normal sized adrenal glands. Besides, DHEAS, 17_OHP, Test and FTest showed significant positive correlation with adrenal volumes (r values: +0.64, +0.62, +0.62, +0.61, respectively; all p values <0.0001). The NCAH patients had larger adrenal glands reflecting increased ACTH stimulation and higher mean DHEAS, 17_OHP, Test and FTest levels compared to the NAH group and controls. With respect to normal subjects, in the NAH group DHEAS levels were higher but still within normal range and there was no difference in adrenal volumes. We conclude that the assessment of AV with spiral CT shows significant correlation with the glands' androgenic activity and spiral CT could be worthwhile in differentiating NCAH cases among hirsute women. The higher plasma DHEAS levels in the absence of adrenal enlargement in NAH patients when compared to normal subjects suggest us a slight androgenic hyperactivity of the adrenal glands in idiopathic hirsutism.
Keywords: Hirsutism, idiopathic hirsutism, adrenal volume, androgens, adult-onset congenital adrenal hyperplasia