URINARY 17-KETOSTEROID CONJUGATES IN HIRSUTISM

Abstract

Six cases of Stein-Leventhal syndrome and ten cases of "idiopathic hirsutism" have been studied. The urinary 17-ketosteroids (17KS) have been separated as sulfoconjugated and glucurono-conjugated forms, and the free steroids derived from each conjugated group have been fractionated and measured after paper chromatog-raphy. In the Stein-Leventhal syndrome, androsterone and etiocholanolone were significantly elevated, with androsterone showing the more marked elevation. In addition, androsterone sulfate and etiocholanolone sulfate were higher than the corresponding glucuronosides. Dehydroisoandrosterone (sulfoconjugated) was constantly and significantly elevated while the 11-oxygenated 17KS (glucuronoconjugated) were only slightly increased. After concomitant dexamethasone and chorionic gonadotrophin administration, dehydroisoandrosterone and 11-oxygenated 17KS were not detectable; but abnormally high levels of androsterone and etiocholanolone persisted, especially of androsterone and etiocholanolone sulfates, with etiocholanolone sulfate predominating. In idiopathic hirsutism, androsterone and etiocholanolone sulfates particularly the former were elevated but disappeared after adrenal suppression and ovarian stimulation. After this test, androsterone and etiocholanolone glucuronosides were variable. In the untreated patients with idiopathic hirsutism, dehydroisoandrosterone and 11-oxygenated 17KS were variable, and were not detectable after dexamethasone administration. The usefulness of these findings as a diagnostic test and their implication in the pathogenesis of these conditions is discussed.