Somatostatin treatment reduces the exaggerated response of adrenocorticotropin hormone and cortisol to corticotropin-releasing hormone in polycystic ovary syndrome

Objective: To evaluate the influence of somatostatin analogue (octreotide) in the function of hypothalamic-pituitary-adrenal (HPA) axis in women with polycystic ovary syndrome (PCOS). Setting: Women referred to the Department of Obstetrics and Gynecology, Universita Cattolica del Sacro Cuore. Patient(s): Twelve PCOS women and 12 normo-ovulatory controls. Intervention(s): In early follicular phase, 1 μg/kg human corticotrophin- releasing hormone (CRH) was injected at 9:00 A.M. and blood samples were collected for 90 minutes after stimulus; ACTH and cortisol plasma levels were measured. The following day at 8:00 A.M., PCOS patients received an ACTH test (250 μg IV) and samples were collected 60 minutes after injection. After 6 weeks of octreotide treatment (100 mg SC twice daily), PCOS patients repeated the same study. Main Outcome Measure(s): Plasma cortisol and ACTH concentrations. Result(s): The ACTH and cortisol baseline levels were similar in PCOS and control patients. The responses to human CRH of ACTH (incremental area = 437.86 ± 188.7 versus 175.78 87.6 pmol/L; mean ± SD) and cortisol (incremental area = 17,293.6 ± 4,320.3 versus 5,885 (912.1 nmol/L) were significantly greater in PCOS with respect to control subjects. After octreotide treatment, ACTH response significantly decreased and no difference was observed with respect to controls (incremental area = 176.94 ± 91.4). Cortisol responses were decreased by treatment. However, they remained significantly higher than in controls. Treatment did not modify adrenal response to IV ACTH. Conclusion(s): Data suggest that, in the HPA axis, hyperfunction of PCOS somatostatin could be involved partially.