GAS CHROMATOGRAPHIC ESTIMATION OF URINARY Δ⁵PREGNENETRIOL AND PREGNANETRIOL IN ADRENOCORTICAL DISEASE AND MALE HYPOGONADISM

Abstract

Urinary Δ⁵-pregnenetriol (Δ⁵-pregnane-3β, 17α, 20α-triol) and pregnanetriol (5β-pregnane-3α, 17α, 20α-triol) were measured by the previously reported gas chromatographic method in the following subjects: 26 normal adults (male 16, female 10), 5 cases with primary aldosteronism, 13 with Cushing's syndrome (bilateral adrenal hyperplasia 5, adrenal adenoma 4, adrenal carcinoma 4), 9 with adrenogenital syndrome (congenital adrenal hyperplasia 7, virilizing adrenal adenoma 2) and 5 cases with male hypogonadism. In normal adults, mean values for urinary excretion of Δ⁵-pregnenetriol and pregnanetriol were 0.15±0.09 (S. D.) mg/day and 0.29±0.17 (S. D.) mg/day, respectively. These two steroids were increased by ACTH. The response of Δ⁵-pregnenetriol to ACTH suggests that there exists a biosynthetic pathway of cortisol which goes through 17α-hydroxypregnenolone. Our observation that urinary Δ⁵-pregnenetriol and pregnanetriol increased by the administration of human chorionic gonodotropin appears to suggest that these two urinary steroids are of testicular origin.
The two steroids were within normal ranges both in primary aldosteronism and in male hypogonadism. Among patients with adrenogenital syndrome, urinary Δ⁵-pregnenetriol and pregnanetriol were equally high in congenital adrenal hyperplasia and in virilizing adrenal adenoma. However, the urinary excretion of pregnanetriolone (5β-pregnane-3α, 17α, 20α-triol-11-one) and pregnanetetrol (5β
-pregnane-3α, 11β, 17α, 20α-tetrol) is characteristically high in congenital adrenal hyperplasia, while these steroids were not detected in virilizing adrenal adenoma. With regard to cases of Cushing's syndrome, urinary Δ⁵-pregnenetriol and pregnanetriol were within normal limits in patients with adrenal hyper-plasia or adrenal adenoma. However, it was noteworthy that patients with adrenal adenoma excreted lesser amounts of Δ⁵-pregnenetriol compared to those with adrenal hyperplasia. On the other hand, patients with adrenal carcinoma excreted outstandingly large amounts of Δ⁵-pregnenetriol and pregnanetriol, especially the former. From these data it is concluded that the measurement of Δ⁵-pregnenetriol is advisable in cases of Cushing's syndrome, especially in cases with adrenal tumor and that the steroid is characteristically high in carcinoma to an extent enough to warrant differential diagnosis from adenoma.