Fractionation of urinary 17-ketosteroids by gas chromatography: a neglected procedure in the assessment of hyperandrogenicity in the hirsute female.

17-Ketosteroids were determined by gas chromatography in twenty four-hour urine samples from 62 hirsute females. The method permitted the determination of androsterone (A), aetiocholanolone (E) and dehydroepiandrosterone (D). Elevated concentrations of one or more of these metabolites were detected in 81% of the samples. Two main patterns of hyperandrogenicity were observed: 1) Hyper A + E (27%) and 2) Hyper A (26%). Elevated AD, AED, D, ED or E were less common, but in total these patterns comprised another 28%. The plasma testosterone and total urinary 17-ketosteroid concentrations were elevated in only 21% and 23% of the samples, respectively. Thirty two out of 33 patients with elevated urine metabolites showed significant suppression following dexamethasone administration (2 mg/day during 6 days). Thus, dexamethasone suppressable hyperandrogenicity was predominant in this group of hirsute females. Elevations of urinary androsterone and aetiocholanolone are probably contingent on the relative activities of 5 alpha- and 5 beta-reductases) in the presence of increased androstenedione secretion. Elevations of urinary dehydroepiandrosterone suggest decreased adrenal cortical 3 beta-hydroxysteroid dehydrogenase) activity. Thus, fractionation of urinary 17-ketosteroids seems to be an effective test in the evaluation of hirsutism.