Effect of Short Term Adrenal Suppression on Androgen Overproduction in Overweight Girls With Androgen Excess

This study will test whether short-term suppression of adrenal function can ameliorate
androgen (male hormone) overproduction in overweight girls with androgen excess. The
investigators hypothesize that one month of oral hydrocortisone administration will improve
androgen levels in girls with adrenal androgen overproduction. Specifically, this
intervention will improve androgen levels after adrenal stimulation testing with
adrenocorticotropin hormone (ACTH).

Inclusion Criteria:

- Overweight(>85th BMI%) females

- Early to late puberty (expected age range 7-18)

- 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:

- Screening labs outside of age-appropriate normal range

- Hemoglobin <12 mg/dL and hematocrit<36% (Subjects will be offered the opportunity to
take iron supplementation for 60 days if their hematocrit is slightly low (33-36%)
(suggestive of iron deficiency anemia) and will then return for retesting of their
hemoglobin/hematocrit. If still <36%, they will be excluded.)

- Morning Cortisol <5 g/dL

- 17-hydroxyprogesterone >295 ng/dL

- History of Cushing's syndrome or adrenal insufficiency

- Pregnant