title: Androsterone glucuronide is a marker of adrenal hyperandrogenism in hirsute women.
abstract: Androsterone glucuronide (Andros-G), a dihydrotestosterone metabolite, is present in serum at concentrations at least tenfold greater than those of androstanediol glucuronide. To investigate the significance of serum androsterone glucuronide, we developed a direct radioimmunoassay for this compound and measured its levels in normal women, women with mild or severe idiopathic hirsutism (IH), hirsute women with polycystic ovarian syndrome (PCO), and non-hirsute obese women. To determine the source of Andros-G precursors, serum levels were measured before and after selective ovarian suppression with leuprolide, combined ovarian and adrenal suppression with leuprolide and dexamethasone, and adrenal stimulation with ACTH. Androsterone glucuronide levels (nmol/l; mean +/- SD) were significantly higher (P less than 0.025) in women with mild idiopathic hirsutism (IH) (185 +/- 91), severe IH (173 +/- 97), and hirsute women with polycystic ovarian syndrome (PCO) (178 +/- 102) than in normal women (110 +/- 26). Levels in non-hirsute obese women (64 +/- 19) were lower than in normal women (P less than 0.01). Baseline levels (mean +/- SEM) in hirsute women given 20 micrograms/kg/day leuprolide for 5-9 months (171 +/- 15) were not significantly changed after leuprolide alone (153 +/- 18), and were decreased after adding dexamethasone (19 +/- 6; P less than 0.001). Andros-G levels did not increase significantly in normal women 60 min after i.v. ACTH (112 +/- 14 to 126 +/- 19), but rose in IH (170 +/- 24 to 216 +/- 26; P less than 0.001) and in PCO (179 +/- 26 to 238 +/- 31; P = 0.002). We conclude that Andros-G in women arises primarily from adrenal gland precursors and is elevated in hirsute women as a group. Its levels do not correlate with the severity of hirsutism, or the presence or absence of PCO, but reflect an increased production of adrenal androgens in both IH and PCO.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia.
authors.forename: D L
authors.initials: DL
authors.lastname: Thompson
authors.forename: N
authors.initials: N
authors.lastname: Horton
authors.forename: R S
authors.initials: RS
authors.lastname: Rittmaster
mesh_terms: D000311:Adrenal Glands / Q000187:drug effects; D000324:Adrenocorticotropic Hormone / Q000494:pharmacology; D000328:Adult; D000728:Androgens / Q000096:biosynthesis; D000738:Androsterone / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000494:pharmacology; D006628:Hirsutism / Q000097:blood* / Q000150:complications; D006728:Hormones / Q000494:pharmacology; D006801:Humans; D016729:Leuprolide; D008875:Middle Aged; D010053:Ovary / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications; D011863:Radioimmunoassay
chemical_list: D000728:Androgens; D015415:Biomarkers; D006728:Hormones; C027927:androsterone glucuronide; D007987:Gonadotropin-Releasing Hormone; D003907:Dexamethasone; D000324:Adrenocorticotropic Hormone; D000738:Androsterone; D016729:Leuprolide