The origin of and metabolic fate of deoxycorticosterone and deoxycorticosterone sulfate in pregnant women and their fetuses.

DOC and DOC-SO4, which are present in large amounts in the blood of pregnant women, are derived from sources other than maternal adrenal. Other investigators demonstrated that treatment of near-term pregnant women with ACTH or dexamethasone did not cause alterations in the blood levels of DOC. To define the source(s) of DOC and DOC-SO4 in plasma of pregnant women, we evaluated the conversion of plasma progesterone (P) to DOC in extraadrenal sites. DOC is formed from plasma P and, provided that the pregnancy is one characterized by the usual large production of estrogen, DOC production in a given woman is proportional to the level of P in plasma. Unlike other steroid conversions or interconversions, however, the fractional conversion of P to DOC among apparently normal persons varied widely 0.011 +/- 0.003 (mean +/- SEM, n = 40, range = 0.001 to 0.030). In women pregnant with a normal living fetus, the product of the production rate of P and the fractional conversion of P to DOC is sufficient to account for the majority of DOC produced in the mother. There may be a second source of DOC, i.e. the transfer of DOC from the fetal to the maternal compartment in a manner that involves (a) direct transfer of DOC by way of trophoblast and (b) by desulfurylation of DOC-SO4 from fetal umbilical arterial plasma in trophoblast and thence transfer of DOC liberated in trophoblast to the maternal compartment. Presently, it is clear that DOC-SO4 in blood of pregnant women is not derived from plasma DOC; and there is little or no evidence in support of the proposition that DOC-SO4 (as a sulfoconjugate) is transferred from the fetal to the maternal compartment because of placental hydrolysis to DOC. Among the extraadrenal tissue sites identified as those in which 21-hydroxylation of plasma P could be effected are some also believed to be tissue sites of mineralocorticosteroid action, viz, kidney, aorta, thymus, and spleen. Quantitatively, the origin of DOC in the fetus is not as clear as in the maternal compartment; yet, many tissues of the fetus have been identified in which both steroid 21-hydroxylase and 21-hydroxysteroid sulfotransferase activity are present. Thus, in the human fetus, extraadrenal as well as adrenal production of DOC and DOC-SO4 are possible.