Effect of Longer-term Adrenal Suppression Using Low Dose Hydrocortisone on Androgen Overproduction

Inclusion Criteria:

- Overweight(>85th BMI%) females

- Early puberty defined by Tanner 1-2 breast development (expected age range 7-16)

- Hyperandrogenemic (free testosterone greater than 2.5 standard deviations above the
mean for normal control subjects of the same Tanner Stage)

- Screening labs within age-appropriate normal range, with the exception of a mildly low
hematocrit (see below) and the hormonal abnormalities inherent in obesity which could
include mildly elevated luteinizing hormone (LH), lipids, testosterone, prolactin,
DHEAS, E2, glucose, and insulin; and decreased follicle-stimulating hormone (FSH)
and/or sex hormone-binding globulin (SHBG)

Exclusion Criteria:

- Age < 7 or > 16 y

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

- BMI-for-age < 5th percentile

- Positive pregnancy test or lactation.

- Screening labs outside of age-appropriate normal range (Abnormal laboratory studies
will be confirmed by repeat testing to exclude laboratory error)

- Morning cortisol < 5 µg/dL or history of Cushing syndrome or adrenal insufficiency

- History of congenital adrenal hyperplasia or 17-hydroxyprogesterone > 295 ng/dL, which
suggests the possibility of congenital adrenal hyperplasia (if postmenarcheal, the
17-hydroxyprogesterone will be collected during the follicular phase, or ≥ 40 days
since last menses if oligomenorrheic). NOTE: If a 17-hydroxyprogesterone >295 mg/dL is
confirmed on repeat testing, an ACTH-stimulated 17-hydroxyprogesterone <1000 ng/dL
will be required for study participation.

- Total testosterone > 150 ng/dL, which suggests the possibility of a virilizing
neoplasm

- DHEAS greater than the upper limit of age-appropriate normal range (mild elevations
may be seen in polycystic ovary syndrome (PCOS) and adolescent hyperandrogenemia (HA),
and elevations < 1.5 times the age-appropriate upper limit of normal will be accepted
in these groups)

- Virilization

- Previous diagnosis of diabetes, fasting glucose ≥126 mg/dL, or a hemoglobin A1c ≥6.5%

- Abnormal thyroid stimulating hormone (TSH) for age. Subjects with stable and
adequately treated hypothyroidism, reflected by normal TSH values, will not be
excluded.

- Abnormal prolactin. Mild elevations may be seen in overweight girls, and elevations
<1.5 times the upper limit of normal will be accepted in this group.

- Persistent hematocrit <36% and hemoglobin <12 g/dL. Subjects with a mildly low
hematocrit (33-36%) will be asked to take iron in the form of ferrous gluconate for up
to 60 days. Subjects weighing ≤ 36 kg will take one 300-325 mg tablet oral ferrous
gluconate daily (containing 36 mg elemental iron);subjects weighing >36 kg will take
two 300-325 mg tablets oral ferrous gluconate daily (containing 36 mg elemental iron
each). They will return to the Clinical Research Unit (CRU) after 30-60 days of iron
therapy to have their hemoglobin or hematocrit rechecked and will proceed with the
remainder of the study if it is ≥12 g/dL or ≥36%, respectively.

- Persistent liver test abnormalities, with the exception that mild bilirubin elevations
will be accepted in the setting of known Gilbert's syndrome. Mild elevations may be
seen in overweight girls, so elevations <1.5 times the upper limit of normal will be
accepted in this group.

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

- Abnormal sodium, potassium, or bicarbonate concentrations, or elevated creatinine
concentration (confirmed on repeat)

- No medications known to affect the reproductive system or glucose metabolism can be
taken in the 3 months prior to the study. Such medications include oral contraceptive
pills, progestins, metformin, glucocorticoids, and psychotropics.