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SUMMARY
The relationship between 17-oxogenic steroid excretion and the urinary output of certain 17-oxosteroids has been widely used to select women with metastatic breast cancer for ablation of endocrine organs. In this report, the effect of factors other than breast cancer on the ratio of androsterone plus aetiocholanolone to the 17-oxogenic steroids in urine is examined. For 83 normal women the mean value of the ratio was 0·351 ± 0·121 (s.d.). In menstruant women the ratio did not correlate with oestrogen excretion, and was little affected by increasing age, the taking of oral contraceptive tablets, obesity, and the presence of reversible amenorrhoea. Factors causing a marked reduction in the ratio were the absence of functional ovaries (47 women, mean ratio 0·116 ± 0·066), food deprivation (15 obese women, mean decrease by the 9th day of starvation, 53·4 ± 11·7%), and adrenocortical stimulation (14 women, mean decrease on day 2 of corticotrophin infusion, 52·0 ± 17·0%). Suppression of adrenocortical function with dexamethasone treatment caused no systematic change in the value of the ratio, and hirsutism was associated with a significant increase (67 women, mean value 0·447 ± 0·165). The variability of the ratio from day to day in individual women (coefficient of variation, 20·7%) suggests that it is inadvisable to select patients for treatment on the basis of measurements made on a single 24 h sample of urine.
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SUMMARY
A simplified method for the estimation of the urinary 17-hydroxycorticosteroids which contain a keto or a hydroxyl group in the 20 position, is described. The method is rapid, is suitable for the analysis of large numbers of samples, and can be used reliably in the presence of glucose. Normal values are given.
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Urine for the analysis of pregnanediol, oestrogens, FSH and LH, was collected weekly from 50 normal menstruant women. Twenty of these women were aged ≥ 40 years and had a history of regular menstrual cycles; they are termed premenopausal. The other 30 reported a recent break in regular cyclicity and are termed perimenopausal. All menstrual cycles observed in the premenopausal women were ovulatory in type and 25–30 days in length. The 124 cycles observed in the perimenopausal women were 18–260 days in length (median, 29 days), with 52% of the ovulatory type. To describe this diversity, a systematic classification is proposed based on (1) the excretion of pregnanediol in the 12 days preceding menstruation (classes I–IV), (2) gonadotrophin output (categories A–E, and L), and (3) the length of the menstrual cycle in days. The premenstrual surge of pregnanediol was greatest in class I cycles and diminished progressively until it became undetectable in class IV. Gonadotrophin excretion was lowest in category A cycles and increased progressively until all levels were within the postmenopausal range by category E. In cycles of category L only LH (and not FSH) was raised.
In the perimenopausal women 37 cycles included episodes of high gonadotrophin excretion (categories C–L), a phenomenon which was not seen in the premenopausal women. These cycles were usually longer than 50 days and were often anovulatory in type (classes II—IV). Typically they began with the high gonadotrophin levels and the low oestrogens which characterize the postmenopausal state, and ended after a rise in oestrogen output to levels ≥ 70 nmol/24 h. It is concluded that 'anovulatory' cycles and cycles in which there are 'postmenopausal' levels of FSH and LH are common in the perimenopause and that they are rare in premenopausal women.
