PATTERNS OF STEROID EXCRETION IN THREE TYPES OF POST-PUBERTAL HIRSUTISM

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Abstract
SUMMARY: The steroid excretion of patients with three types of post-pubertal hirsutism has been studied both before and during the administration of corticotrophin. The types of hirsutism distinguished were post-pubertal adrenal virilism (three cases), idiopathic hirsutism (five cases) and the Stein-Leventhal syndrome (seven cases). 1. The patients in the adrenal virilism group were found to have a pattern of steroid excretion of the type seen in congenital adrenal hyperplasia. Thus they excreted relatively small amounts of cortisol metabolites in the urine, but the excretions of pregnanetriol, 17-hydroxypregnanolone, 11-oxopregnanetriol and 11-hydroxyandrosterone were high. 2. The patients with idiopathic hirsutism showed a tendency to excrete relatively more of those 17-oxosteroids derived from C19 precursors compared with those derived from cortisol. The evidence suggests, however, that this disproportion is due not to an impairment of cortisol synthesis but to a potentiation of the production of adrenal androgens. 3. A similar abnormality in the patterns of steroid excretion was also found in some of the patients with the Stein-Leventhal syndrome. Since this abnormality includes the excretion of increased amounts of those 17-oxosteroids thought to be exclusively of adrenal origin, viz. dehydroepiandrosterone and 11-hydroxyandrosterone, this would suggest adrenal involvement in at least some of the cases.