Assessment of Day-night Secretion of Progesterone and LH Across Puberty
Assessment of Day-night Secretion of Progesterone and LH Across Puberty
Hormones are substances that are made by the body and are sent directly out into the
 bloodstream to increase or decrease the function of certain organs, glands, or other
 hormones. Testosterone is a hormone found in the blood of all girls, but some girls have too
 much testosterone in their blood. Too much testosterone in the blood can possibly lead to a
 problem called polycystic ovary syndrome (PCOS). People with PCOS have abnormal menstrual
 periods, excess facial and body hair, and too much testosterone in their blood. On the other
 hand, some girls with too much testosterone in their blood do not develop PCOS. We do not
 know why some of these girls develop PCOS and why some do not. The purpose of this research
 study is to find out whether too much testosterone can cause problems with other hormones
 that can lead to the development of PCOS. This study may help us understand more about the
 causes of PCOS.
Polycystic ovary syndrome (PCOS) is a common disorder marked by irregular ovulation and
 hyperandrogenism. Hyperandrogenemia during adolescence can be a forerunner of adult PCOS.
 However, the progression of hormonal abnormalities leading to PCOS are unclear. We will
 examine hormonal profiles (e.g., LH, FSH, progesterone, testosterone, estradiol) during
 pubertal maturation in adolescent girls with and without elevated plasma androgens. The
 working hypothesis is that, in pubertal girls without hyperandrogenemia, overnight rises of
 progesterone are associated with a reduction of LH frequency during the waking morning hours.
 However, in pubertal girls with hyperandrogenemia, LH frequency will be higher than normal
 during both the day and night, despite similar or higher progesterone levels. The studies
 will involve frequent blood sampling over 18 hours. We will assess differences in hormone
 parameters between time blocks (1900-2300 h, 2300-0300 h, 0300-0700 h, 0700-1100 h) in
 individuals to evaluate day-night changes. We will compare such changes between those with
 hyperandrogenemia and those without hyperandrogenemia.
Inclusion Criteria:

 -  Early and late pubertal girls with normal androgens

 -  Early and late pubertal girls with hyperandrogenemia

 -  All subjects will be girls from pre-puberty (Stage 1 breast development and pubic hair
 growth but at least 7 years old) to 7 years post menarche.

 Exclusion Criteria:

 -  Pregnancy

 -  Inability to comprehend what will be done during the study or why it will be done

 -  Hemoglobin <11.5 g/dL for non-African American subjects; Hemoglobin < 11.0 g/dL for
 African American subjects

 -  Persistently abnormal sodium, potassium, or bicarbonate (i.e., confirmed on repeat)

 -  Persistently elevated creatinine, hepatic transaminases, or alkaline phosphatase
 (i.e., confirmed on repeat)

 -  Total bilirubin > 1.5 times upper limit of normal (i.e., confirmed on repeat)

 -  Significant history of cardiac or pulmonary dysfunction (e.g., known or suspected
 congestive heart failure; asthma requiring intermittent systemic corticosteroids;
 etc.)

 -  Untreated hypo- or hyperthyroidism (reflected by persistently abnormal TSH values)

 -  Total testosterone > 200 ng/dl

 -  Basal (follicular) 17-OHP > 200 ng/ml (in girls without a previous diagnosis of
 congenital adrenal hyperplasia)

 -  DHEA-S > 800 mcg/dl

 -  Elevation of prolactin > 2 times upper limit of normal

 -  Weight less than 25 kg