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Salivary and Plasma Androstenedione and 17-Hydroxyprogesterone Levels in Congenital Adrenal Hyperplasia

Department of Paediatrics, University of Nijmegen Nijmegen, The Netherlands
Department of Experimental and Chemical Endocrinology, University of Nijmegen Nijmegen, The Netherlands

Address requests for reprints to: Dr. Th. J. Benraad, Department of Experimental and Chemical Endocrinology, Medical Faculty, University of Nijmegen, Geert Grooteplein Zuid 8, Postbus 9101, 6500 HB Nijmegen, The Netherlands.

Androstenedione (A-dione) and 17-hydroxyprogesterone (17-OHP) levels were measured in matched samples of saliva and of plasma collected from patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (eight patients) and 11-hydroxylase deficiency (one patient). Positive correlations were found between salivary and plasma values of either steroid with correlation coefficients of 0.968 for A-dione and 0.935 for 17-OHP.

All five inadequately treated patients with 21-hydroxylase deficiency had greatly elevated plasma and salivary 17-OHP concentrations compared to values in age matched controls. In two of three well controlled patients plasma 17-OHP levels were less than 40 nmol/liter and salivary levels were less than 1.5 nmol/liter, the upper limits which have been formulated as a guideline for monitoring control in treated CAH patients. Patients in good control had A-dione levels in plasma (0.6–2.2 nmol/liter) and saliva (0.04–0.15 nmol/liter) which were both within the normal range for prepubertal children (0.14–2.40 nmol/liter and 0.02–0.25 nmol/liter respectively). Patients in poor control had A-dione levels in plasma of 5.2–25.4 nmol and in saliva of 0.50 –2.21 nmol/liter. These values exceeded without exception the normal ranges for their respective ages. Salivary A-dione and 17-OHP determinations are a useful adjunct in the diagnosis and the monitoring of CAH patients since they can be obtained easily and nonstressfully.

¹ The following abbreviations and trivial names are used: 17-hydroxyprogesterone (17-OHP), 17-hydroxy-pregnen-4-en-3,20-dione; pregnanetriol (P3), 5β-pregnan-3,17,20-triol; tetrahydro substance S (THS), 5β-pregnan-3,17,21 triol-20-one; dexamethasone, 1,4-pregnadien-9-fluoro-16-methyl-11β,17,21-triol-3,20-dione; cortisone acetate; 4-pregnen-17,21-diol-3,11,20-trione 21-acetate; fludrocortisone, 9-fluoro-11β,17,21-trihydroxypregn-4-ene-3,20dione.

Received March 14, 1983.

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