The identification of urinary bile alcohols by gas chromatography–mass spectrometry in patients with liver disease and in healthy individuals

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Abstract
The neutral steroid fractions in the urine of 11 patients suffering from various forms of liver disease with cholestasis and of 10 healthy individuals were studied by glass capillary gas chromatography-mass spectrometry. The steroid conjugates in urine were enzymatically solvolyzed, the liberated steroids extracted and transformed into the trimethylsilylether for measurements. The excretion rates of androstane and pregnane metabolites of patients with liver disease were far lower than those of healthy persons. The main compounds in the urine of the former were the bile alcohols 27-nor-3.alpha.,7.alpha.,12.alpha.,24.xi.,25.xi.-pentahydroxy-5.beta.-cholestane and 3.alpha.,7.alpha.,12.alpha.,25.xi.,26-pentahydroxy-5.beta.-cholestane. A correlation is suggested between the excretion rates of the bile alcohols and the serum levels of bilirubin. While the excretion rate of the 2 bile alcohols in the urine of healthy individuals was .apprx. 0.24 mg/24 h (0.6 .mu.mol/24 h) a patient with a serum bilirubin of 841 .mu.mol/l excreted 4 mg/24 h (9 .mu.mol/24 h). This accumulation of bile alcohols possibly indicates alternative pathways of cholic acid formation in liver disease.

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