Miles R A, Cassidenti D L, Carmina E, Gentzschein E, Stanczyk F Z, Lobo R A
University of Southern California School of Medicine, Los Angeles.
Fertil Steril. 1992 Oct;58(4):708-12. doi: 10.1016/s0015-0282(16)55316-3.
Assessment of an in vivo test for 5 alpha-reductase activity using serum markers, 5 alpha-androstane-3 alpha,17 beta-diol glucuronide and androsterone glucuronide, after the cutaneous application of androstenedione (A).
An A gel was applied for 6 days to the skin of normal women, male volunteers, and hirsute and nonhirsute patients with polycystic ovarian syndrome (PCOS). Blood samples were obtained at baseline and on day 6 of the A gel application. Blood samples were assayed for A, 5 alpha-androstane-3 alpha,17 beta-diol glucuronide, and androsterone glucuronide. In three hirsute women, the protocol was followed before and after receiving an oral contraceptive (OC) and spironolactone 200 mg/d for 3 months.
The study was performed in the outpatient clinic of the Division of Reproductive Endocrinology and Infertility, Women's Hospital of the Los Angeles County and University of Southern California Medical Center in Los Angeles, California.
PATIENTS, PARTICIPANTS: A total of eight nonhirsute patients with PCOS, seven hirsute patients with PCOS, and six male volunteers were enrolled in the study. Five normal women served as a control group.
Serum A increased after 6 days by a similar magnitude in all groups. Serum androsterone glucuronide showed a significant increase from baseline only in the hirsute group (P < 0.03), whereas the increase in 5 alpha-androstane-3 alpha,17 beta-diol glucuronide was not statistically significant.
The ratio of the increases in serum androsterone glucuronide over serum A was significantly higher in the hirsute group (P < 0.02). In the three hirsute patients who were placed on an OC and spironolactone, serum 5 alpha-androstane-3 alpha,17 beta-diol glucuronide and androsterone glucuronide decreased after 3 months and did not increase with application of the gel for another 6 days.
The cutaneous application of A provides a useful assessment of in vivo 5 alpha-reductase activity. However, because we found that A absorption varied considerably (30% to 62%), we suggest that this in vivo test may not provide more information than baseline determinations of 5 alpha-androstane-3 alpha,17 beta-diol glucuronide and androsterone glucuronide. It may, however, be useful as a parameter for assessing the effectiveness of various treatment regimens for hirsutism.
在皮肤涂抹雄烯二酮（A）后，利用血清标志物5α-雄烷-3α,17β-二醇葡糖苷酸和雄酮葡糖苷酸评估体内5α-还原酶活性的检测方法。
将A凝胶涂抹于正常女性、男性志愿者以及患有多囊卵巢综合征（PCOS）的多毛和非多毛患者皮肤6天。在基线期以及涂抹A凝胶的第6天采集血样。对血样进行A、5α-雄烷-3α,17β-二醇葡糖苷酸和雄酮葡糖苷酸检测。在3名多毛女性中，在接受口服避孕药（OC）和2螺旋内酯200mg/d治疗3个月前后遵循该方案。
该研究在加利福尼亚州洛杉矶市洛杉矶县妇女医院和南加州大学医学中心生殖内分泌与不孕科门诊进行。
患者、参与者：共有8名非多毛PCOS患者、7名多毛PCOS患者和6名男性志愿者纳入研究。5名正常女性作为对照组。
6天后所有组血清A均有相似幅度的升高。血清雄酮葡糖苷酸仅在多毛组较基线有显著升高（P<0.03），而5α-雄烷-3α,17β-二醇葡糖苷酸的升高无统计学意义。
多毛组血清雄酮葡糖苷酸升高值与血清A升高值的比值显著更高（P<0.02）。在接受OC和螺旋内酯治疗的3名多毛患者中，3个月后血清5α-雄烷-3α,17β-二醇葡糖苷酸和雄酮葡糖苷酸降低，再次涂抹凝胶6天后未升高。
皮肤涂抹A可对体内5α-还原酶活性进行有效评估。然而，由于我们发现A的吸收差异很大（30%至62%），我们认为该体内检测方法可能并不比5α-雄烷-3α,17β-二醇葡糖苷酸和雄酮葡糖苷酸的基线测定提供更多信息。不过，它可能作为评估各种多毛症治疗方案有效性的一个参数有用。
