DIAGNOSTIC SIGNIFICANCE OF URINARY HORMONAL ASSAYS: REPORT OF EXPERIENCE WITH MEASUREMENTS OF 17-KETOSTEROIDS AND FOLLICLE STIMULATING HORMONE IN THE URINE

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Abstract
Tests more generally available at this time are: those for detecting pregnancy and those for measurement of 17-ketosteroids, follicle-stimulating pituitary gonadotropin, and pregnandiol. Tests for measuring estrogens and the glycogenic adrenal corticoids give promise of more widespread clinical acceptance. Experience with 488 tests for 17-ketosteroids and 233 tests for FSH at the University of California Hospital has been reviewed. Normal ranges from our experience were compared with those of other authors. Low values for 17-ketosteroids were found in the following conditions: Hypophyseal infantilism, Simmonds'' disease, anorexia nervosa, Addison''s disease, myxedema and severe asthma. The avg. for Simmonds'' disease was lower than that for anorexia nervosa, but there was overlapping in the ranges of the 2. High levels of 17-ketosteroid excretion were found in adrenal cortical carcinoma and hyper-plasia. When further separation into alpha and beta fractions of the 17-ketosteroids was done, the beta fraction was particularly elevated in the patients with carcinoma. However, one patient with adrenal cortical carcinoma showed normal values. Slightly high and slightly low levels are obtained in a number of conditions but are of limited clinical value because of the considerable daily variation in 17-ketosteroid output in the same individual. Normal 17-ketosteroid excretion occurred in hypogonadism, ovarian aplasia, gynecomastia, simple amenorrhea, oligospermia, obesity, alopecia and various psychiatric disorders. Urinary FSH was always high in ovarian aplasia, was occasionally high in the male and female climacteric, seeming more consistent in the latter, in eunuchoidism, and in hyperthecosis. A high value was found in one female castrate. A low level of FSH excretion was noted in patients with hypophyseal infantilism, Simmonds'' disease and anorexia nervosa. Some eunuchoids also showed a low level of FSH excretion, and may represent a separate group from those with high values. Normal values for FSH excretion were encountered in acromegaly, anorexia nervosa, hyperthyroidism, hypo-thyroidism, Cushing''s syndrome, adrenal cortical hyperplasia, simple hirsutism, Addison''s disease, gynecomastia, the climacteric, hyperthecosis, oligospermia, and alopecia.