Gibson M, Lackritz R, Schiff I, Tulchinsky D
Fertil Steril. 1980 Jan;33(1):43-8. doi: 10.1016/s0015-0282(16)44475-4.
The plasma concentrations of testosterone (T), dehydroepiandrosterone (D), androstenedione (A), pregnenolone (delta 5P), progesterone (P), 17-hydroxypregnenolone (17-delta 5P), 17-hydroxyprogesterone (17-P), 11-deoxycortisol (S), and cortisol (F) were measured before, and 30 and 60 minutes after, a bolus intravenous injection of 25 units of adrenocorticotropic hormone (ACTH) in nine normal women and in fifteen patients with a variety of manifestations of androgen excess. Patients with androgen excess demonstrated significantly higher mean baseline levels of T, D, A, delta 5P, 17-delta 5P, and 17-P. After a bolus intravenous injection of 25 units of ACTH, higher-than-normal increments were noted for the following steroids: delta 5P (one patient), 17-delta 5P (one patient), D (two patients), P (one patients), 17-P (two patients), and S (two patients). Following ACTH injections, the ratios of increments in plasma steroid pairs were computed to estimate the efficiency of several adrenal enzymes, and evidence suggesting partial deficiency of 3 beta-hydroxysteroid dehydrogenase delta 4-5 isomerase (five patients) and 11 beta-hydroxylase (five patients) was found. In addition, 6 of the 15 patients with androgen excess exhibited an abnormally high increment in D relative to the increment in F. The data show that apparent abnormalities in adrenal steroid biosynthesis are a frequent occurrence in patients with hyperandrogenism.
在9名正常女性和15名有各种雄激素过多表现的患者中，静脉推注25单位促肾上腺皮质激素（ACTH）前、推注后30分钟和60分钟分别测定血浆睾酮（T）、脱氢表雄酮（D）、雄烯二酮（A）、孕烯醇酮（δ5P）、孕酮（P）、17-羟孕烯醇酮（17-δ5P）、17-羟孕酮（17-P）、11-脱氧皮质醇（S）和皮质醇（F）的浓度。雄激素过多的患者表现出T、D、A、δ5P、17-δ5P和17-P的平均基线水平显著更高。静脉推注25单位ACTH后，以下类固醇出现高于正常的增量：δ5P（1例患者）、17-δ5P（1例患者）、D（2例患者）、P（1例患者）、17-P（2例患者）和S（2例患者）。注射ACTH后，计算血浆类固醇对增量的比值以评估几种肾上腺酶的效率，发现有证据提示3β-羟类固醇脱氢酶δ4-5异构酶部分缺乏（5例患者）和11β-羟化酶部分缺乏（5例患者）。此外，15例雄激素过多患者中有6例相对于F的增量，D的增量异常高。数据表明，肾上腺类固醇生物合成的明显异常在高雄激素血症患者中很常见。
