Journal of Clinical Endocrinology & Metabolism, Vol 78, 299-304, Copyright © 1994 by Endocrine Society

ARTICLES

Plasma 3 beta-hydroxy-delta 5-steroids in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

J Young, B Couzinet, M Pholsena, K Nahoul, F Labrie and G Schaison
Service d'Endocrinologie et des Maladies de la Reproduction, Hopital Bicetre, Kremlin Bicetre, France.

There is little information about the plasma concentrations of 3 beta- hydroxy-delta 5-steroids (delta 5-steroids) in untreated patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. To further study the delta 5 pathway, we measured plasma levels of delta 5- and delta 4-steroids in 21 adult patients with different degrees of 21- hydroxylase deficiency (11 salt-wasters, 5 simple virilizers, and 5 patients with the nonclassical form of the disease). In all patients, investigations were performed after withdrawal of steroid treatment for at least 10 days. In addition, catheterization of gonadal and adrenal veins was performed in two salt-wasting male patients displaying bilateral testicular tumors to study adrenal secretion of delta 5- and delta 4-steroids. In one of them, surgical resection of the intratesticular adrenal rests gave the opportunity to measure 3 beta- hydroxysteroid dehydrogenase (3 beta HSD) activity. In all untreated patients, an increase in plasma delta 4-steroids was observed. In contrast, although plasma levels of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) were not significantly modified in simple virilizers, a paradoxical decrease in all delta 5-steroids was observed in salt-wasters. Catheterization of the adrenal veins confirmed the decrease in delta 5-steroids, particularly DHEA and DHEAS. The androstenedione/DHEA ratio was increased in all patients proportionally to the severity of the disease, suggesting an increase in adrenal 3 beta HSD. In vitro analysis of 3 beta HSD activity showed a 4-fold increase in intratesticular adrenal tissue compared to that in normal adrenals. A positive correlation between the androstenedione/DHEA ratio and plasma ACTH levels was observed, suggesting a long term stimulatory effect of ACTH on 3 beta HSD. Angiotensin-II could have an additive effect on ACTH-induced 3 beta HSD activity.

This article has been cited by other articles:

				J. Young, P. Chanson, S. Salenave, M. Noel, S. Brailly, M. O'Flaherty, G. Schaison, and R. Rey Testicular Anti-Mullerian Hormone Secretion Is Stimulated by Recombinant Human FSH in Patients with Congenital Hypogonadotropic Hypogonadism J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 724 - 728. [Abstract] [Full Text] [PDF]

				H. Murphy, C. George, D. de Kretser, and S. Judd Successful treatment with ICSI of infertility caused by azoospermia associated with adrenal rests in the testes: Case report Hum. Reprod., February 1, 2001; 16(2): 263 - 267. [Abstract] [Full Text] [PDF]

				J. Young, B. Couzinet, P. Chanson, S. Brailly, E. Loumaye, and G. Schaison Effects of Human Recombinant Luteinizing Hormone and Follicle-Stimulating Hormone in Patients with Acquired Hypogonadotropic Hypogonadism: Study of Sertoli and Leydig Cell Secretions and Interactions J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3239 - 3244. [Abstract] [Full Text]