Plasma 17-Ketosteroids and Testosterone in Prepubertal Children Before and After ACTH Administration1

Abstract

Children's excretion of 17-ketosteroids in response to ACTH is known to be relatively low compared to adults. The plasma C-19 precursors of urinary 11-deoxy-17-ketosteroids have been measured in the endocrinologically normal child to determine the nature of the response to ACTH. Plasma androgen levels (mean ±sem) in a control group of prepubertal children were: testosterone 5.2±1.5, androstenedione 18.0±4.8, and dehydroepiandrosterone 48.1±8.5 ng/100; dehydroepiandrosterone sulfate 6.3±1.8 /μg/100 ml. These levels were below the adult female range in each subject. Five 6 to 11-yr-old children with rheumatic valvulitis were given ACTH gel 50 U/m2 im for 1 week as initial therapy. Base-line plasma concentrations of unconjugated C-19 steroids in the rheumatic subjects were not significantly different from the controls: testosterone 6.7±2.5, androstenedione 15.2±4.3, dehydroepiandrosterone 71.6±19.6 ng/100 ml. Following ACTH, these increased in each child to adult female levels, 22.3±3.9, 149±22, and 347±95 ng/100 ml, respectively. Dehydroepiandrosterone sulfate similarly rose from 13.7±3.2 to 62.8±24 μg/100 ml. It is, therefore, concluded that increased plasma levels of all adrenal androgenic secretory products result from protracted ACTH administration to children. The pattern of plasma androgen levels after ACTH seems characterized by a disproportionately low rise in the concentration of dehydroepiandrosterone compared to that of androstenedione. The extent to which the rise in plasma androgens is due to secretion of individual 17-ketosteroids from the adrenal and the extent to which it is due to peripheral formation from secreted precursors remain unknown.