Zwicker H, Rittmaster R S
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
J Clin Endocrinol Metab. 1993 Jan;76(1):112-6. doi: 10.1210/jcem.76.1.8380602.
Androsterone sulfate (Andros-S) is the most abundant 5 alpha-reduced androgen metabolite in serum. To determine whether this steroid could serve as a marker of 5 alpha-reductase activity, we developed a specific RIA, using tritiated Andros-S to assess procedural losses. Baseline serum Andros-S levels (mumol/L; mean +/- SEM) in 14 hirsute women (3.0 +/- 0.4) were not reduced by ovarian suppression with leuprolide (3.0 +/- 0.3), but were decreased by 79% with combined ovarian and adrenal suppression with leuprolide and dexamethasone. The mean Andros-S level in polycystic ovarian syndrome (3.2 +/- 0.4) and in idiopathic hirsutism (3.5 +/- 0.5) was not significantly different from levels in normal women (3.0 +/- 0.5), but were significantly greater than levels in obese women (1.7 +/- 0.3; P < 0.05). The serum concentrations of Andros-S were about 10-fold greater than those of androsterone glucuronide and 100-fold greater than those of androstanediol glucuronide. Serum Andros-S concentrations correlated strongly with dehydroepiandrosterone sulfate (R = 0.59; P < 0.001) and to a lesser degree with androstanediol glucuronide and androsterone glucuronide (R = 0.28 and 0.49, respectively). There was a weak correlation with androstenedione levels and the androstenedione response to ACTH (R = 0.38 and 0.34, respectively), and no significant correlation with serum testosterone (R = 0.19). The ratio of any of the 5 alpha-reduced products (Andros-S, androstanediol glucuronide, and androsterone glucuronide) to precursors (androstenedione and testosterone) was not increased in hirsute women, suggesting that these women did not have a generalized increase in 5 alpha-reductase activity. In conclusion, these results confirm that Andros-S is the most abundant 5 alpha-reduced androgen metabolite in serum. It is primarily, if not exclusively, of adrenal origin in hirsute women. The fact that its levels were not elevated in hirsutism, although those of other adrenal androgens and androgen metabolites (androstanediol glucuronide and androsterone glucuronide) were, suggests that variations in sulfotransferase activity or metabolic clearance of Andros-S may be important determinants of serum Andros-S levels. Although Andros-S may be a marker of systemic 5 alpha-reductase activity, there was no evidence of a generalized increase in 5 alpha-reductase activity in hirsute women. Andros-S is therefore not recommended as a marker of either adrenal androgen production or of hirsutism.
硫酸雄酮（Andros-S）是血清中含量最丰富的5α-还原雄激素代谢物。为了确定这种类固醇是否可作为5α-还原酶活性的标志物，我们开发了一种特异性放射免疫分析法（RIA），使用氚标记的Andros-S来评估操作过程中的损失。14名多毛女性的基线血清Andros-S水平（μmol/L；均值±标准误）为（3.0±0.4），用亮丙瑞林抑制卵巢后未降低（3.0±0.3），但联合使用亮丙瑞林和地塞米松抑制卵巢和肾上腺后降低了79%。多囊卵巢综合征患者（3.2±0.4）和特发性多毛症患者（3.5±0.5）的平均Andros-S水平与正常女性（3.0±0.5）相比无显著差异，但显著高于肥胖女性（1.7±0.3；P<0.05）。血清中Andros-S的浓度约比雄酮葡萄糖醛酸苷高10倍，比雄烷二醇葡萄糖醛酸苷高100倍。血清Andros-S浓度与硫酸脱氢表雄酮密切相关（R = 0.59；P<0.001），与雄烷二醇葡萄糖醛酸苷和雄酮葡萄糖醛酸苷的相关性较弱（分别为R = 0.28和0.49）。与雄烯二酮水平及雄烯二酮对促肾上腺皮质激素（ACTH）的反应有弱相关性（分别为R = 0.38和0.34），与血清睾酮无显著相关性（R = 0.19）。多毛女性中任何一种5α-还原产物（Andros-S、雄烷二醇葡萄糖醛酸苷和雄酮葡萄糖醛酸苷）与前体（雄烯二酮和睾酮）的比值均未升高，这表明这些女性的5α-还原酶活性没有普遍增加。总之，这些结果证实Andros-S是血清中含量最丰富的5α-还原雄激素代谢物。在多毛女性中，它主要（如果不是唯一的话）来源于肾上腺。尽管其他肾上腺雄激素和雄激素代谢物（雄烷二醇葡萄糖醛酸苷和雄酮葡萄糖醛酸苷）水平升高，但多毛症患者中Andros-S水平并未升高，这表明硫酸转移酶活性或Andros-S的代谢清除率变化可能是血清Andros-S水平的重要决定因素。尽管Andros-S可能是全身5α-还原酶活性的标志物，但没有证据表明多毛女性的5α-还原酶活性普遍增加。因此，不推荐将Andros-S作为肾上腺雄激素产生或多毛症的标志物。
