Metabolism and concentration of androgenic steroids in abdominal skin of hirsute women with androgenital syndrome.

An in vitro study has been made of the steroid metabolism in the abdominal skin in two hirsute women with adrenogenital syndrome, and the concentrations of the various steroids in the skin tissue have been determined. The urinary excretion of the total 17-Ks, and particularly P-triol, was pathologically high, while of the androgens examined in the serum, primarily the levels of delta 4-dione and Test, were found to be elevated. The 21-hydroxylase deficiency meant that the plasma ACTH level was likewise extremely high in both patients. In vitro incubation studies demonstrated that in one patient (with the higher androgen overproduction) more Test. than normal was formed from the precursors (DHA, delta 5-diol, delta 4-dione), i.e. the biosynthetic pathway (17 beta-HSD, delta 5-3 beta-HSD) leading towards the androgens was enhanced in the abdominal skin. In the other patient (where the androgen production was less high as a consequence of the earlier adrenalectomy) the metabolism in the abdominal skin was not enhanced; indeed, for many metabolites the extent of the transformation did not even attain the level for normal women. The activity of Test. 5 alpha-reductase was not increased in the skin of either patient. The results on the steroid contents of the skin tissue revealed that numerous free steroids (DHA, And., delta 4-dione, delta 5-diol, Test., DHT) and C19-steroid sulphates were present in higher concentrations than in the abdominal skin of healthy women. The extents of steroid accumulation compared to the serum level in the same patient were pathologically high in the case of delta 5-diol, DHT and DHA-S in the abdominal skin of the two hirsute women with adrenogenital syndrome. This confirmed that a state of hyperandrogenism does exist in the skin of these patients.