ABNORMAL URINARY ANDROSTERONE/ETIOCHOLANOLONE RATIO IN HYPOTHALAMIC DISTURBANCES IN MAN

Abstract

ABSTRACT The urinary androsterone/etiocholanolone (A/E) ratio was determined in 233 normal subjects. Compared with these, a group of 28 cases of adiposo-genital dystrophy (a.-g. d.) in boys and men showed a very considerable increase in the A/E ratio. It is shown by analyses in 23 cases of primary testicular failure and male castration and in 17 cases of exogenous obesity that this change in a.-g. d. is not secondary to the main symptoms, i. e. obesity and hypogonadism; neither can it be explained on a thyroid basis. Studies of 2362 fractionated 17-KS-determinations performed in all kinds of endocrine disorders showed that an elevated A/E ratio is found in certain conditions all of which are of hypothalamic origin. Furthermore it was found that an elevated A/E ratio was present in verified organic damage of the hypothalamus. In a number of a.-g. d. cases the A/E ratio was followed up to 10 years through the puberal age. Usually the ratio remained unaffected by the great puberal rise in the excretion of A and E. In contrast to the others some patients showed a fall in the ratio during puberty and these usually showed satisfactory gonadal development. Determination of the A/E ratio before and after the administration of a large dose of testosterone propionate was done in 23 cases of hypothalamic dysfunction and in 22 other cases. The abnormal A/E ratios in hypothalamic cases were reproduced during the metabolism of exogenous testosterone, which shows that the abnormal ratios originate from an abnormal androgen metabolism and not from abnormal hormone production. The findings indicate that there is, in man, a central regulation of androgen metabolism in which the hypothalamus is involved. The diagnostic, pathogenetic and theoretical implications of the findings are discussed.