Testosterone/epitestosterone ratio in urine: a possible diagnostic tool in the disclosure of exogenous testosterone administration.
A 37-year-old woman presented with a history of secondary amenorrhoea and hirsutism for 4 years. She had elevated serum levels of testosterone and dihydrotestosterone, and decreased serum levels of sex hormone binding globulin and oestradiol. Almost daily use of a testosterone-containing ointment in the vulvar region for 6 years was disclosed as the cause of the hyperandrogenism. Serum testosterone, testosterone excretion rate in urine and testosterone/epitestosterone ratio in urine were determined at fixed intervals 24 h before and 48 h after application of the testosterone-containing ointment. There was a rapid increase in serum testosterone, with a peak level after 4-6 h. The testosterone excretion rate and the testosterone/epitestosterone ratio in urine peaked after 2-4 h. After 48 h the serum testosterone level was still about twice the basal value. The testosterone/epitestosterone level was over the 'doping limit' of 6 for 28 h. We conclude that determination of the testosterone/epitestosterone ratio in urine would have disclosed exogenous testosterone administration in this patient. We recommend this test for patients in whom exogenous testosterone administration is suspected.
Adamski
D
D
Department of Medicine, Aker University Hospital, Oslo, Norway.
Homa
T
T
Kempf-Haber
M
M
Kołodziejski
L
L
Wiecheć
M
M
Wojtyś
A
A
Klimek
M
M
D000287:Administration, Topical; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D004359:Drug Therapy, Combination; D004845:Epitestosterone / Q000652:urine*; D005260:Female; D005621:Friedreich Ataxia / Q000150:complications; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D017512:Lichenoid Eruptions / Q000150:complications / Q000188:drug therapy*; D013739:Testosterone / Q000008:administration & dosage / Q000009:adverse effects* / Q000652:urine; D014770:Virilism / Q000139:chemically induced / Q000150:complications / Q000652:urine*; D014845:Vulvar Diseases / Q000150:complications / Q000188:drug therapy*
C021650:hydrocortisone acetate; D013739:Testosterone; D004845:Epitestosterone; D006854:Hydrocortisone