Urine tests evaluate levels of cortisol, cortisone, precursor pregnanetriol
, dehydroepiandosterone, sex hormones including estrogens, progesterone and testosterone and various cortisol metabolites including tetrahydrocortisone, all-tetrahydrocortisol, tetrahydrocortisol and other byproducts.
, and cortisol metabolites concentrations were within reference ranges.
levels are low which suggest failure of LH production, ovulation & resultant menorrhagia.
In the presence of the Cushing syndrome the following observations were made that represent urinary excretion rates (mg/24h) of the steroid metabolites tetrahydrocortisone (in the second column below) and pregnanetriol
(in the third column).
The diagnosis can be definitive by measuring a 17-OHP metabolites in the urine, namely 17-hydroxy pregnenolone (17-OHP, normal value is 63-279 mg/24 hours), pregnanetriol
(PT, normal value is 179-992 mg/24 hours), 21-deoxycortisol metabolite pregnanetriolone (PTN, normal value is 3.5-50 mg /24 hours) (44).
levels are low which suggests failure of LH production, ovulation and resultant menorrhagia.
(14) found that growth velocity was a better predictor of the ratio of bone age to chronologic age than 24-h urine pregnanetriol
(PT) or single morning 17OHP concentrations (see below).
Adrenal Steroid Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Pregnanediol H H H H L 0 Androsterone H H H H L 0 Etiocholalone H H H N N 0 DHEA H H N L N 0 Pregnanetriol
H H N L N 0 11-Ketoandrosterone H H N L N 0 11-ketoetiocholalone H N L L L 0 11-OH-androsterone H L L N L 0 * Case 1:54-yr-old woman hypertension, diverticulitis, palpitations, and severe Katribarelated stress.
* Elevated levels of pregnanetriol
indicate congenital adrenal hyperplasia.
The diagnosis of CAH was based on clinical classification and hormonal indicators (17-hydroxyprogesterone plasma concentration, pregnanetriol
and pregnanetriolone concentrations in urine, and plasma renin activity).