Comparison between urinary 17-ketosteroids and serum androgens in hirsute patients.

In order to ascertain the usefulness of urinary 17-ketosteroids (17-KS) in the evaluation of hirsutism, 28 paired determinations of 17-KS and serum androgens were performed in 26 hirsute women before (control) and after (post Dex) 7 days of dexamethasone (Dex) administration. Upper normal control and post Dex urinary 17-KS and serum steroid levels were as follows: 17-KS, 15 and 5 mg/24 hour urine collection; dehydroepiandrossterone sulfate (DHEA-S), 2500 and 400 ng/ml serum; testosterone (T), 0.5 and 0.3 ng/ml; dihydrotestosterone (DHT), 0.35 and 0.2 ng/ml; androstenedione (A), 2.3 and 1.6 ng/ml; androst-5-ene-3beta-17beta-diol (delta5-diol), 1.6 and 0.4 ng/ml; and cortisol (F), 140 and 40 ng/ml. In 5 of the 28 tests, control 17-KS levels were elevated. In these 5 tests, control serum levels of one or more androgens were also elevated. DHEA-S was the only steroid of which the serum levels were elevated in all these 5 patients. Control 17-KS were within normal limits in 23 tests. Of these, 19 had elevated serum androgens. Nine patients with elevated post Dex urinary 17-KS also had elevated post Dex levels of serum androgens. Of 19 patients with normal post Dex 17-KS, 14 had elevated post Dex serum androgen levels. These data indicate that 1) urinary 17-KS determinantions do not reliably identify patients with elevated serum androgens; 2) Dex suppression of 17-KS does not correlate well with Dex suppression of serum androgens; and 3) for the evaluation of hyperandrogenism, measurements of serum androgens give a better understanding of the type of androgens involved and the source of hyperandrogenism.

Serum cortisol and 11-desoxycortisol levels in hirsute premenopausal women.

It has been postulated that hirsute patients may have a relative deficiency in 11beta-hydroxylase activity of the adrenal cortex. In order to test this postulate, we have measured the serum levels of cortisol (Cp F) and 11-desoxycortisol (Cp S) and estimated the Cp S/Cp F ratio in 9 nonhirsute and 34 hirsute premenopausal women. As a group, the hirsute patients had significantly elevated (P less than 0.05) mean Cp F and Cp S levels but the mean Cp S/Cp F ratio was not significantly different from normal. Considered individually, only 3 hirsute patients had a Cp S/Cp F ratio greater than 2 SD above the mean normal levels. These ratios were 0.0218, 0.0139, and 0.023. If there is indeed an 11beta-hydroxylase deficiency in these 3 patients, it must be relatively minor, since a patient with documented 11beta-hydroxylase deficiency had Cp S levels of 218 ng/ml and a Cp S/Cp F ratio of 0.7. Our data suggest that 11beta-hydroxylase deficiency is not a common cause of hirsutism.

Combined radioimmunoassay of four steroids in one ml of plasma: I. Progestins.

Using partially specific antisera combined with a 1 step celite microcolumn chromatography, progesterone (P), 20alpha-hydroxypregn-4-ene-3-one (20alpha-P), 17-hydroxyprogesterone (17-P), and 16alpha-hydroxyprogesterone (16alpha-P) could be measured in the same 1 ml aliquot of plasma. The chromatographic step removed known interfering steroids and conferred specificity to the assay. After correction for recovery the sensitivities, expressed as ng/ml of plasma, were respectively: 0.04 for P, 0.03 for 20alpha-P, 0.02 for 17P, and 0.01 for 16alpha-P. Recovery experiments, using steroid-free plasma to which various amounts of each steroid were added and then measured in the assay in 12 replicates, confirmed adequate accuracy and precision. The ability to measure multiple progestogens in small volumes of plasma should permit comprehensive evaluation of the role of these steroids in health and disease.

Combined radioimmunoassay of four steroids in one ml of plasma: II. Androgens.

Using partially specific antisera combined with a 1 step celite microcolumn chromatography, androstenedione (A), 5alpha-dihydrotestosterone (DHT), testosterone (T), and androst-5-ene-3beta, 17beta-diol (delta 5-diol) could be measured in the same 1 ml aliquot of plasma. The chromatographic step removed known interfering steroids and conferred specificity to the assay. After correction for recovery the sensitivities, expressed as ng/ml of plasma, were respectively: 0.025 for A, 0.05 for DHT, 0.025 for T, and 0.1 for delta5-diol. Recovery experiments, using steroid-free plasma to which various amounts of each steroid were added and then measured in the assay in 12 replicates, confirmed adequate accuracy and precision. The ability to measure multiple androgens in small volumes of plasma should permit comprehensive evaluation of the role of these steroids in health and disease.