Conventional diagnostic procedures failed to provide a definitive diagnosis in a 15 year-old girl presenting with severe hirsutism, oligomenorrhea, and markedly elevated serum testosterone levels. To examine whether androgen overproduction was luteinizing hormone (LH) dependent and thus likely of ovarian origin we performed a new test to suppress LH secretion based on the use of Cetrorelix, a short-acting gonadotropin-releasing hormone antagonist. Subcutaneous administration of Cetrorelix 250 microg once daily for 5 days resulted in partial suppression of serum LH and testosterone. The same dose administered twice daily for 5 days almost completely suppressed serum LH and testosterone, thereby supporting a diagnosis of ovarian androgen excess. This observation was confirmed by a positive human chorionic gonadotropin stimulation test and an MRI showing bilateral polycystic ovaries.
Conclusion: The Cetrorelix suppression test appears to be a promising instrument to help solve the differential diagnosis of severe hyperandrogenism in adolescence.