SUN-489 Persistent Normalization of Androgens and Symptom Resolution Following a Single Two-Day Dexamethasone Suppression Test in a Patient with PCOS

Abstract Disclosure: M.V. Perez Bastidas: None. A. Imran: None. S.A. McKenzie: None. O. Oudit: None. Y. Cho Yoon: None. Z. Deribe: None. F. Zhang: None. K. Kodroff: None. Background: Hyperandrogenemia in women can result from various etiologies, including polycystic ovary syndrome (PCOS), nonclassical congenital adrenal hyperplasia (NCCAH), and androgen-secreting tumors. Persistent hyperandrogenemia resistant to conventional treatments poses a diagnostic and therapeutic challenge. Case Presentation: A 39-year-old female presented with a five-year history of alopecia and secondary amenorrhea. She had a known history of PCOS but had never been treated with oral contraceptives. Her physical examination revealed obesity (BMI 38 kg/m²), significant acanthosis nigricans, and no clinical features of Cushing’s syndrome. Laboratory evaluation demonstrated markedly elevated total testosterone (264 ng/dL) and free testosterone (6.0 pg/mL), with a normal DHEA-S (193 μg/dL). Prolactin, ACTH, estradiol, TSH, and androstenedione were within normal limits. A 1 mg overnight dexamethasone suppression test appropriately suppressed cortisol (0.6 μg/dL). A CT scan of the abdomen showed a 7 mm thickening of the medial limb of the left adrenal gland. A 17-hydroxyprogesterone level was measured at 23 ng/dL. A transvaginal ultrasound, performed around the time of the CT scan, was unremarkable. Due to the significantly elevated testosterone levels, a two-day low-dose dexamethasone suppression test (LDST) was performed, with 2 mg of dexamethasone administered daily. Following LDST, total testosterone fell to undetectable levels (<3 ng/dL) and DHEA-S decreased to 23 μg/dL. Six weeks post-LDST, the patient experienced spontaneous resumption of menses and improvement in alopecia. At three and six months post-LDST, total testosterone remained within the normal range (9 ng/dL), and DHEA-S remained low (89.8 μg/dL). She continued to have regular menstrual cycles with a gradual resolution of hyperandrogenic symptoms. Conclusion: This case highlights a potential novel therapeutic approach for hyperandrogenemia. While chronic glucocorticoid therapy has been used in select cases, long-term use is limited by side effects. This case suggests that intermittent, short-term glucocorticoid administration may provide a prolonged suppressive effect on androgen levels and associated symptoms. Further studies are warranted to explore the mechanisms and clinical applicability of this approach in managing hyperandrogenemia. Presentation: Sunday, July 13, 2025