The inability of adrenal androgens to stimulate the adult human prostate: An autopsy evaluation of men with hypogonadotropic hypogonadism and panhypopituitarism

Although it is well recognized that testicular androgens provide the major hormonal stimulus to the prostate the role of adrenal androgens is less certain. Recently, it has been suggested that total androgen ablation (adrenal and testicular) is necessary to achieve a complete response to hormonal therapy in men with carcinoma of the prostate. In an effort to elucidate the influence of adrenal androgens on prostatic growth, we reviewed autopsy findings in patients (mean age 65 years, with a range of 57 to 80 years) from 3 distinct groups: group 1 consisted of 4 men with neither adrenal nor testicular function since before puberty (panhypopituitarism), group 2 included 4 men with normal adrenal glands but no testicular function throughout life (hypogonadotropic hypogonadism or prepubertal castration) and group 3 consisted of 8 age-matched controls with normal adrenal glands and normal testes. To assess the degree of androgenic stimulation each prostate was examined by a genitourinary pathologist and was analyzed morphometrically with respect to epithelial cell height, epithelial cell height:nuclear height ratio, acinar area and short axis diameter of randomly selected acini. All prostates in groups 1 and 2 were atrophic histologically, while all prostates in group 3 were enlarged and demonstrated varying degrees of benign psoriatic hyperplasia. Morphometric analysis of the 3 groups revealed the same results. For all 4 parameters studied morphometrically there was no statistical difference between groups 1 and 2. However, a statistical difference did exist for these criteria when either 1 (p less than 0.0001) or group 2 (p less than 0.0001) was compared to group 3. These findings suggest that normal adrenal glands do not have a significant stimulatory effect on the human prostate and that they are not capable of supporting prostatic growth.