17-ketosteroids in 24 hour urine

Indications

• diagnosis of pituitary Cushing's syndrome
• used in conjunction with metyrapone stimulation test

Reference interval

• adult
  • male: 10-25 mg/day (35-87 umol/day)
  • female: 6-14 mg/day (21-49 umol/day)

Increases

• pharmaceutical agents
  • in-vivo effects
    • corticotropin, danazol, gonadotropins, metyrapone, testalactone, testosterone
  • chemical interferences
    • cephalosporins, erythromycin, ketoprofen, meprobamate, nalidixic acid, penicillamine, spironolactone, troleandomycin
• clinical disorders
  • Cushing's syndrome
  • ectopic ACTH-producing tumors
  • adrenal tumors
    • higher values for adrenal carcinoma than for adrenal adenoma
  • virilizing forms of congenital adrenal hyperplasia
  • Stein-Leventhal syndrome
  • testicular tumors (large increases)
  • interstitial cell tumors (large increases)
  • arrhenoblastoma & lutein cell tumors of the ovary

Decreases

• pharmaceutical agents
  • in-vivo effects
    • androgens, corticosteroids, corticotropin, dextropropoxyphene, estrogens, morphine (chronic), phenytoin, probenecid, pyrazinamide
  • chemical interferences
    • carbamazepine, chlordiazepoxide, glucose
• clinical disorders
  • Addison's disease
  • congenital adrenal hyperplasia (adrenogenital syndromes)
  • hypopituitarism
  • hypothyroidism
  • generalized wasting syndrome
  • nephrosis
  • primary male hypogonadism
    • Klinefelter's syndrome
    • castration

Methods

• colorimetric (Zimmerman)

Specimen

• urine, 24 hours
• preserve with boric acid & refrigerate
• stable for at least 2 weeks & for longer periods if frozen at -20 degrees C

Notes

• test has largely been replaced by serum DHEA-sulfate levels as a marker of adrenal androgen production

More general terms

• 24 hour urine
• 17-ketosteroids in urine

Additional terms

• 17 ketosteroid
• 17-hydroxycorticosteroids in 24 hour urine
• 17-ketogenic steroids in 24 hour urine
• metyrapone stimulation test