Androgens

What sample is needed for Androgens?

1. This may be done on 24-hour urine samples.
2. Venous blood is needed to prepare the serum.
   1. Keep the serum on ice or cool, and perform the test within one hour.
   2. The serum sample can be stored at 4 °C for 2 days or months at -20 °C.
3. Collect the sample from females at least one week before or after the menstrual cycle.
   • Take 3 to 5 ml of blood in the disposable syringe. Keep the syringe for 15 to 30 minutes and then centrifuge for 2 to 4 minutes. This will give a clear serum.

What are the Indications for Androgens?

1. This test is done to evaluate virilizing syndrome in females:
   1. Excessive hair growth.
   2. Irregular period.
   3. Infertility.
2. This test can evaluate the adrenal glands’ function.
3. This test is done to assess delayed puberty.
4. D/D of Cushing syndrome (DHEA-S).

How will you define androgens?

 How would you discuss the pathophysiology of Adrenal Androgens?

1. The most important androgens are:
   1. Dehydroepiandrosteronene (DHEA).
   2. Dehydroepiandrosterone-sulfate (DHEA-SO4). It is a metabolite of DHEA.
      1. Daily production in young men is 30 mg/day and 20 mg/day in young women.
      2. Its half-life is 8 to 11 hours.
      3. Its half-life is 30 to 60 minutes for unconjugated androgens.
      4. DHEA and DHEA-S levels fall during illness, depression, and other stresses.
   3. Testosterone. It is the major and main hormone.
2. Adrenal androgens peak between 20 and 30 years of age and then gradually fall.
3. Androstenedione and DHEA are androgenic steroids produced by the adrenal cortex, ovaries, and testes.
4. These are metabolically converted into testosterone and other androgens. 
5. Adrenal androgens are produced from the Zona fasciculta and Zona reticularis from pregnenolone and 17-OH pregnenolone.

9. The peripheral tissue converts these hormones into a relatively high level of testosterone.
10. In females, androstenedione from peripheral tissues and ovaries is converted into testosterone and estrogen.

11. DHEA and DHEA-S are precursors of testosterone and estrogen produced by the gonads and adrenal glands.
12. DHEA-S is produced at 8 to 16 mg/day, which is more than 90% of the plasma circulation.
13. Androstenedione is elevated and gives rise to hirsutism and virilization.

14. ACTH stimulates the secretion of the adrenal glands.

What are the Adrenal androgens?

1. It changes with age. It starts around 9 years of age, just before puberty onset.
2. The peak level is around the third decade.
3. ACTH controls the adrenal gland secretions. ACTH partially regulates the adrenal cortex secretion in adults.
   1. DHEA and androstenedione are secreted along with cortisol.
   2. Glucocorticoid therapy suppresses the secretion of adrenal androgens.
   3. The adrenal cortex’s average secretion is:
      1. DHEA = 4 mg/day.
      2. DHEA-S = 10 mg/day.
         1. Its half-life is 8 to 11 hours.
      3. Testosterone = 0.05 mg/day.
      4. Androstenedione = 1.5 mg/day.

What are the Androgens in females?

1. The mean androgen production rate in women is:
   1. Testosterone = 0.25 mg/day.
   2. Androstenedione = 3.4 mg/day (during menstrual period).
      1. 1.6 mg/day during the menopausal period.
   3. DHT (Dihydrotestosterone) = 0.056 mg/day
2. In Female testosterone:
   1. 50% to 60% is made from peripheral tissues.
   2. 30% is produced by the adrenal glands.
   3. 20% is produced from the ovary.

What are the Androgens in males?

1. Testosterone is the main androgen in males and leads to:
   1. Masculinization of the male genital tract.
   2. Maturation of male secondary sex characteristics.
   3. Increase muscle bulk and bone mass.
   4. Increase Libido.
   5. Increase sexual performance in males.
   6. The main androgen production rate in males is:
      1. Testosterone = 7 mg/day.
      2. Androstenedione = 1.4 mg/day.
      3. DHT (Dihydrotestosterone) = 0.3 mg/day.

What are the effects of a raised level of androstenedione?

1. Hirsutism.
2. Change in voice
3. Sterility.
4. This test is done to differentiate sex character problems.
   1. This test may help assess delayed puberty.
5. DHEA is an androgenic steroid that both men and women secrete.

 How would you discuss the DHEA secretion?

1. DHEA levels gradually increase during childhood and adolescence, rise rapidly after puberty, peak at age 20, and then decline.
2. It decreases in the elderly more rapidly than other steroids.
3. There is a moderate decrease in pregnancy.
4. DHEA and Androstenedione have diurnal variations, with the highest secretion in the morning. Similar to cortisol, they secrete episodically.
5. DHEA-S does not show diurnal variation and is present in the serum at much higher levels than DHEA and Androstenedione.
   1. Polycystic ovary (Stein-Leventhal syndrome) = High level of Androstenedione.
   2. Adrenal carcinoma = High level of DHEA-S.
   3. Cushing’s disease = Moderately raised level of DHEA-S.
      1. Cushing’s syndrome (a benign adrenal tumor) = Normal Androstenedione.
   4. Congenital Adrenal hyperplasia = Moderately raised level of DHEA-S.

How will you measure DHEA?

• DHEA is measured by gas-liquid chromatography, RIA, and gas chromatography.

What are the normal values of  Androgen?

Androstenedione

• Newborn = 20 to 290 ng/dL
• Puberty = 8 to 50 ng/dL
• Male = 75 to 205 ng/dL
• Female = 85 to 275 ng/dL
• Postmenopausal = <10 ng/dL

Another source

• Premature = 80 to 446 ng/dL
• Newborn = 20 to 290 ng/dL
• 1 to 12 months = 6 to 68 ng/dL
• 10 to 17 years = 8 to 240 ng/dL
• Adult
  • Male = 75 to 205 ng/dL
  • Female = 85 to 275 ng/dL
• Source 2
  • Male = 0.6 to 2.7 ng/mL
  • 0.5 to 2.7 ng/mL

Normal Urine DHEA

• Adult male: 0.1 to 2.0 mg/day
• Adult Female: 0.1 to 1.5 mg/day
• Child: Less than 0.1 mg/day

Normal serum DHEA

Source 2

• Adult Male = 1.0 to 9.5 ng /mL
• Adult Female = 0.4  to 3.7 ng /mL
• Pregnant Female = 0.5 to 12.5 mg /mL

Another source

• Male = 180 to 1250 ng/dL
• Female = 130 to 980 ng/dL
  • Urine =
  • Male = <3.1 mg/24 hours
  • Female = <1.5 mg/24 hours

Normal serum DHEA-S

Source 2

• Male = 280 to 640 µg /dL
• Female = 65 to 380 µg /dL

Another source

• Male = 125 to 619 µg /dL
• Female 29 to 781µg /dL

(Different literature gives different values)

What are the causes of increased levels of androgens?

1. Hirsutism.
2. Polycystic Ovarian Syndrome.
3. Virilizing adrenal tumors.
4. Precocious puberty.
5. Cushing disease.
6. Ectopic ACTH-producing tumor.
7. Congenital adrenal hyperplasia.

What are the causes of decreased levels of androgens?

1. Hyperlipidemia.
2. Psychosis.
3. Psoriasis.
4. With the increasing age of men and women.
5. Hypopituitarism.
6. The patient is on glucocorticoid treatment.

Questions and answers: