HYDROLYSIS OF URINARY CONJUGATED 17-KETOSTEROIDS BY ACETATE BUFFER

Measurement of serum levels of dehydroepiandrosterone sulfate: a comparison of radioimmunoassay and enzymatic analysis

Dehydroepiandrosterone sulfate (DHEAS) and unconjugated dehydroepiandrosterone (DHEA) are secretory products of the adrenal cortex. Measurement of serum levels of these steroids is of increasing epidemiologic interest, since low serum concentrations of DHEAS or DHEA have been associated with an increased risk of dying of cardiovascular disease or of developing cancer. Radioimmunoassays (RIAs) are the most convenient systems for the measurement of serum DHEAS concentrations in multiple samples. However, using sera from four individuals we show that different RIA kits provide quite different estimates of serum DHEAS concentrations. Moreover, these results do not always agree with the serum concentrations determined by an independent chromatographic and enzymatic reference method. The results highlight the need for an independent method of determining DHEAS levels in sera that can provide guidance in selecting an appropriate RIA, and in interpreting the results.

Androgen producing adrenal adenoma. Report on a case associated with hyperparathyroidism

In a 41-year-old hirsute woman, severe hypercalcemia led to the discovery of hyperparathyroidism related to the involvement (hyperplasia/or adenoma) of the 4 parathyroid glands. Plasma and urinary DHA, plasma DHA-sulfate and delta 5 steroid precursors were elevated. Steroid hormone hypersecretion was stimulated by hCG and ACTH, and exhibited a paradoxical rise during dexamethasone administration. Computerized tomography scanning as well as arteriography disclosed bilateral adrenal hyperplasia and left adrenal adenoma. Bilateral adrenal vein catheterization indicated a left/right gradient for delta 5 steroids and delta 5 steroid sulfates. At surgery a left brown adrenal encapsulated adenoma was removed with a hyperplastic adrenal gland. Results of in vitro studies (adrenal steroid content and incubation) together with postadrenalectomy hormonal results suggest that the left brown adrenal adenoma was the main source of excessive androgen production. The infrequent association of an androgen-producing adrenal adenoma with hyperparathyroidism raises the hypothesis of multiple endocrine neoplasia syndrome. However, evidence for this diagnosis is lacking in the absence of other glandular involvement and of family history.

Androgen and 19-norsteroid profiles in human preovulatory follicles from stimulated cycles: an isotope dilution-mass spectrometric study

Follicular fluid was aspirated from preovulatory follicles of women under ovarian stimulation for in vitro fertilization and analyzed by a highly specific technique based on gas chromatography-mass spectrometry associated with stable isotope dilution. 19-Nortestosterone and 19-norandrostenedione were identified and quantified for the first time in human follicular fluid. There was a strong positive correlation between 19-nortestosterone and estradiol-17 beta and between 19-norandrostenedione and estrone concentrations, thus indicating a common cellular origin. The accumulation of 19-norsteroids in follicular fluid confirms that they are weakly active intermediates in the multistep enzymatic conversion of androgen to estrogen. Testosterone concentrations were significantly lower than those obtained by radioimmunoassay; cross-reaction with substantially higher levels of 19-nortestosterone seems to be at the origin of this discrepancy. Androstenedione concentrations were similar to those reported in the literature and it was therefore confirmed that an estradiol/androstenedione concentration ratio above 20 is favourable for oocyte cleavage. Other and some newly estimated androgens are: testosterone sulfate, 5-androstene-3 beta, 17 beta-diol 3-sulfate and disulfate, dihydrotestosterone sulfate, epitestosterone, 19-hydroxyandrostenedione, 5 alpha-androstane-3 alpha, 17 beta-diol, 5 alpha-androstane-3 beta, 17 beta-diol, 5 alpha-androstane-3,17-dione and androsterone. Dehydroepiandrosterone sulfate was by far the most abundant androgen in this type of follicles.

Steroid 21-hydroxylation by human preovulatory follicles from stimulated cycles: a mass spectrometrical study of deoxycorticosterone, 21-hydroxypregnenolone and 11-deoxycortisol in follicular fluid

A highly specific technique based on gas chromatography-mass spectrometry associated with stable isotope dilution was applied to the analysis of follicular fluid aspirated from preovulatory follicles of women under ovarian stimulation prior to in vitro fertilization. Deoxycorticosterone, 21-hydroxypregnenolone and 11-deoxycortisol have been identified and quantified in the nanomolar concentration range. Significant positive correlations were found between these 21-hydroxy-steroids and their immediate precursors, thus indicating a probable common cellular origin. Corticosterone was tentatively identified and cortisol was evidenced at concentrations lower than peripheral plasma levels. The occurrence in human follicular fluid of cortisol, together with different high concentration intermediates, constitutes evidence for ovarian intra-follicular 21-hydroxylase activity, and probably also for 11 beta-hydroxylation enzyme activity.

Cortisol, cortisone and dehydroepiandrosterone sulfate levels in umbilical cord and maternal plasma between 21 and 30 weeks of pregnancy

Cortisol (F), Cortisone (E) and dehydroepiandrosterone sulfate (DHAS) were determined in maternal peripheral plasma and umbilical cord plasma between 21 and 30 weeks of amenorrhea. In fetal plasma, DHAS levels were the highest and those of F the lowest. E always exceeded F. The pattern of all these steroids was characterized by a plateau throughout the period considered. In maternal plasma, F levels were more elevated than those of E but lower than DHAS concentrations. All the steroids plateaued as in the fetus. The study of the correlation between the steroids in either the same milieu or in maternal and umbilical cord plasma demonstrated that fetal E was correlated with maternal F and with fetal F while fetal DHAS was inversely correlated with maternal E.

Testicular secretion of conjugated and unconjugated steroids in normal adults and in patients with varicocele. Baseline levels and time-course response to hCG administration

The effects of a single im injection of 10,000 IU of hCG on testicular steroid secretions were studied in 15 normal men and 54 patients with varicocele. Plasma levels of the following steroids were determined by radioimmunoassay: T, DHT, A, DHA, 5Adiol, E1, E2, 5P, 170H5P, 170HP, E1S, E2S, TE1, TE2, DHAS, 5AdiolS and hCG as well as FSH and LH in baseline samples. In normal men, peripheral venous blood was collected at 0, 1, 2, 4, 6, 8, 24, 36, 48, 72 and 96 h after hCG. Three types of steroid response were observed. The first, biphasic with an early peak within 2 h and a delayed one after 24 h, was shown by T, its unconjugated precursors and DHT. The second with an early rise plateauing for 6 h and followed by a 36 h peak characterized the estrogen pattern. Finally DHAS did not demonstrate a significant increase but 5AdiolS fluctuated at higher levels than the baseline ones. A significant correlation was only observed between hCG maximum value and E2 and TE1 maximum relative responses. In the patient group, peripheral blood was collected at 0, 1, 1.5, 2, 4, 6, 8, 10, 24 and 48 h after hCG. Baseline levels of all steroids were similar in the two groups. After hCG the same delayed pattern was observed as in the controls. The early relative response was low for T while A, DHT, E2 and E1S levels decreased. Conversely 170HP was higher until 24 h. Spermatic vein blood was collected before and at 1.5, 24 and 48 h after hCG. Steroid baseline levels in the varicocele side were similar to the other. After hCG, despite very large variations, general steroid patterns were comparable to those observed in peripheral vein blood. The important fall at 24 h of T/170HP and T/170H5P concomitant with that of T/E2 might be related to an inhibition of C17-20 lyase activity. The testicular secretion of all the measured steroids, including E1S, could be demonstrated except for DHAS. From our findings, a biogenetic defect evidenced by the fast response to hCG administration might exist in varicocele patients. In view of these results, the protocol of the hCG test should be improved using more frequent blood sampling and determining, besides T, its precursors and estrogen conjugates.