Androgens and hyperemesis gravidarum: a case–control study

Abstract Objective The pathogenesis of hyperemesis gravidarum (HG) is probably multifactorial, involving several hormones. Androgen concentrations are reported to correlate positively with emesis gravidarum. Hypothesizing a continuum between emesis gravidarum and HG, we investigated androgen concentrations in women with HG. Study design In a case–control study, 32 women hospitalized for HG were compared with 29 control women scheduled for elective surgical abortion. Control women were matched for age, gestational length, body mass index (BMI) and parity. Patient characteristics and concentrations of dehydroepiandrosterone sulphate (DHEAS), androstenedione, testosterone, sex hormone binding globulin (SHBG), free testosterone index (FTI), androstanediol glucuronide (ADG), progesterone, TSH, free T3 and T4, beta-hCG, ferritin, insulin, estradiol and estriol were compared using Mann–Whitney tests and multivariate linear regression analyses. Results Women with HG had higher concentrations of ADG (8.49 ± 4.19 vs. 6.19 ± 1.77 pmol/L; p  = 0.015), estradiol (2.39 ± 1.36 vs. 1.60 ± 9.30 nmol/L; p  = 0.009) and ferritin (186 ± 138 vs. 117 ± 94 pmol/L; p  = 0.040) compared with control women. Androstenedione (5.34 ± 2.82 vs. 6.86 ± 2.67; p  = 0.004) and insulin (63.7 ± 35.0 vs. 75.3 ± 25.8; p  = 0.050) concentrations were lower in women with HG. DHEAS, testosterone, FTI, SHBG, estriol, progesterone, beta-hCG, TSH, free T3 and free T4 concentrations did not differ between the groups. In multivariate regression analyses HG was associated with high concentrations of ADG ( p  = 0.026) and low concentrations of androstenedione ( p  = 0.018). Conclusion Steroid hormone homeostasis may be altered in women with HG. HG may be associated with high ADG and low androstenedione concentrations.