SUBSTRATE DEPENDENCY OF C-19 CONJUGATES IN HIRSUTE HYPERANDROGENIC WOMEN AND THE INFLUENCE OF ADRENAL ANDROGEN

Serum C-19 conjugates, specifically 3 alpha-androstanediol glucuronide (3 alpha G), reflect peripheral androgen action through the action of 5 alpha-reductase activity. The origin of 5 alpha-reduced C-19 conjug ates has been controversial and it has been suggested that they are de rived primarily from adrenal androgens. We examined concentrations of 3 alpha G, 3 alpha-androstanediol sulphate (3 alpha S), androsterone g lucuronide (AoG) and androsterone sulphate (AoS) in 40 hirsute hyperan drogenic women. These patients were divided into four groups based upo n individual, combined or normal concentrations of the adrenal androge ns dehydroepiandrosterone (DHEAS) and 11 beta-hydroxy-androstenedione. Testosterone, unbound testosterone and androstenedione were similar i n these groups. Serum 3 alpha G was equally high in all groups and was correlated significantly with hirsutism, while the other conjugates w ere not. Androsterone glucuronide was raised in all groups but was hig her in patients with raised DHEAS. Serum 3 alpha S was raised in all g roups and was higher where both adrenal androgens were raised. Serum A oS was highly correlated with DHEAS. Serum 3 alpha G was correlated wi th unbound testosterone and androstenedione but not with the adrenal a ndrogens. The glucuronide conjugates were correlated ,vith one another as were the sulphate conjugates but glucuronides and sulphates were n ot correlated. These data confirm ovarian and adrenal dependency of C- 19 conjugates. Serum 3 alpha G appears to reflect hirsutism most accur ately and is least dependent on adrenal androgens in patients with mix ed hyperandrogenism.