SERUM SEX HORMONE CONCENTRATIONS IN INSULIN DEPENDENT DIABETIC WOMEN WITH AND WITHOUT AMENORRHOEA

SUMMARY Abnormal steroid secretion may contribute to anovulation in insulin dependent diabetic patients with amenorrhoea. We have measured serum sex hormonebinding globulin (SHBG) and free and bound oestrogen and androgen levels in 17 such patients. As controls we included 17 patients with insulin dependent diabetes mellitus and normal menstrual cycles, 21 regularly menstruating normal women (both sampled during early follicular phase), and 23 non-diabetic patients with amenorrhoea. The diabetic patients with normal cycles had significantly higher serum concentrations of Δ4-androstenedione and testosterone than the normal women (P>0·01). The amenorrhoeic diabetics in contrast had significantly lower serum concentrations of SHBG, 5 α-dihydrotestosterone and free and total oestradiol-17β than either group of menstruating women (P>0·05), and significantly lower concentrations of Δ4-androstenedione (P > 0·01), dehydroepiandrosterone sulphate (P > 0·01), testosterone (P > 0·01), and oestrone (P > 0·05), than the cycling diabetics. The two amenorrhoeic groups had similar free and bound sex hormone concentrations except that Δ4-androstenedione levels were significantly lower in the diabetics (P>0·01). We conclude that the low sex hormone levels in diabetic women with amenorrhoea may be due to suppression of the hypothalamic-pituitary axis in view of the impaired LH secretion found in these patients and that excess androgen secretion seems not to be of aetiological importance in amenorrhoea related to diabetes mellitus. The decreased steroid levels in amenorrhoeic diabetics is due to their suppressed ovarian function while the increased androgen levels in diabetics with regular cycles are probably of ovarian origin.