Three types of polycystic ovarian syndrome in relation to androgenic function

To re-evaluate the concept of polycystic ovarian syndrome (PCOS) in view of androgenic function. Patients were studied endocrinologically and ultrasonographically. This study was performed as a clinical investigation. Sixty-nine euprolactinemic anovulatory patients with luteinizing hormone (LH) hypersecretion and 18 normal volunteers were selected. One hundred micrograms of LH-releasing hormone were administered. It was possible to divide PCOS patients into three types. Patients with neither hirsutism nor elevation of serum androstenedione (Δ4) and/or testosterone (T) were designated as type I PCOS (n = 20). Patients without hirsutism but with elevated Δ4 and/or T were referred to as type II PCOS (n = 33). Patients with both hirsutism and elevation of Δ4 and/or T were defined as type III PCOS (n = 16). Concentrations of Δ4 appeared gradedly increasing in types I, II, and III in that order, whereas T concentrations were significantly higher in types II and III than in control. Ultrasonographically, cystic ovaries were found in 88%, 84%, and 100% of types I, II, and III patients, respectively. It is postulated that each type may represent a subset of whole spectrum of PCOS from Stein-Leventhal syndrome to simple anovulation with LH hypersecretion.