ABNORMAL URINARY ANDROSTERONE/ETIOCHOLANOLONE RATIO IN HYPOTHALAMIC DISTURBANCES IN MAN

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Abstract
The urinary androsterone/etiocholanolone (A/E) ratio was determined in 233 normal subjects. Compared with these, a group of 28 cases of adiposo-genital dystrophy (a.-g. d.) in boys and men showed a verv considerable increase in the A/E ratio. It is shown by analyses in 23 cases of primary testicular failure and male castration and in 17 cases of exogenous obesity that this change in a. -g. d. is not secondary to the main symptoms, i. e. obesity and hypogonadlsm; neither can it be explained on a thyroid basis. Studies of 2362 fractionated 17-KS-determinations performed in all kinds of endocrine disorders showed that an elevated A/E ratio is found in certain conditions all of which are of hypothalamic origin. Furthermore it was found that an elevated A/E ratio was present in verified organic damage of the hypothalamus. In a number of a.-g. d. cases the A/E ratio was followed up to 10 years through the puberal age. Usually the ratio remained unaffected by the great puberal rise in the excretion of A and E. In contrast to the others some patients showed a fall in the ratio during puberty and these usually showed satisfactory gonadal development. Determination of the A/E ratio before and after the administration of a large dose of testosterone proplonate was done in 23 cases of hypothalamic dysfunction and in 22 other cases. The abnormal A/E ratios in hypothalamic cases were reproduced during the metabolism of exogenous testosterone, which shows that the abnormal ratios originate from an abnormal andro-gen metabolism and not from abnormal hormone production. The findings indicate that there is, in man, a central regulation of androgen metabolism in which the hypothalamus is involved.

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