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.