Urine 17-Ketosteroids Level (24 hours urine)

Sample

1. 24 hours urine sample collected in a container containing 6 ml of HCL acid or one gram of boric acid.
2. When starting the collection, discard the first sample and collect all the samples, including the last sample, when 24 hours are completed.
3. A urine sample will be stable for 2 weeks at 4 °C.
4. For a longer period of time, keep at -20 °C.

Purpose of the test (Indications)

1. This is done to assess:
   1. The adrenal cortex function.
   2. To evaluate and monitor adrenal hyperplasia.
   3. To evaluate and monitor the adrenal tumors.

Precaution

• Stop the medicines which interfere with the result like:

1. Diuretics
2. Aspirin
3. Antibiotics
4. Hormone therapy like Estrogen.
5. Stop birth control medication.

Pathophysiology

1. To understand the 17-ketosteroids formation, we need to understand the adrenal gland function, shown in the following diagram.

2. Androgens and testosterone are metabolized to 17-ketosteroid, and this is the overall measure of androgen production.
3. The main excretory metabolites of:
   1. Testosterone.
   2. Androstenedione.
   3. DHEA
   4. They are collectively called 17-ketosteroids, and this can be quantitated in the urine.
      

      Androgen and 17-Ketosteroids

4. 17-ketosteroids are the metabolites of testosterone and another androgenic sex hormone.
5. 17- Ketosteroid is the end product of dehydroepiandrosterone secreted in the urine.
6. In men:
   1. Roughly 1/3 is produced from the testosterone produced in the testes.
   2. Rest comes from other androgenic hormones produced in the adrenal cortex.
7. In women and children, almost all 17-ketosteroids are non-testosterone androgens produced by the adrenal cortex.
8. 17-Ketosteroids are not the metabolites of Cortisol, so they do not indicate cortisol production.
9. Increased 17-Ketosteroid causes:
   1. Masculinizing syndrome in females.
   2. Precocious puberty in males.
      

      Sources of 17- ketosteroids

Normal

Male	10 to 25 mg /24 hours
Female	6 to 15 mg /24 hours
After the age of 70 years
Male	3 to 12 mg / 24 hours
Female	3 to 13 mg / 24 hours
Infants	<1.0 mg / 24 hours
1 to 4 years	<2 mg / 24 hours
10 to 12 years	1 to 5 mg /24 hours
14 to 16 years male	3 to 13 mg/24 hours
14 to 16 years female	2 to 8 mg/24 hours

The increased level is seen in:

1. Congenital adrenal hyperplasia.
2. Pregnancy.
3. Hyperpituitarism
4. Testosterone secreting or androgen-secreting tumors of:
   1. Ovaries.
   2. Testes
   3. Ectopic ACTH-secreting tumors.
5. Administration of ACTH.
6. Stein-Leventhal syndrome.
7. Cushing’s syndrome.

The decreased level was seen in:

1. Severe stress.
2. Severe infections.
3. Debilitating diseases.
4. Addison’s disease
5. Castration
6. Hypopituitarism
7. Myxedema
8. Nephrosis.
9. Klinefelter’s syndrome.
10. Chronic diseases.
11. Drugs that can decrease 17-ketosteroids include:
    1. Birth control pills
    2. Estrogens
    3. Probenecid
    4. Reserpine
    5. Salicylates (prolonged use)
    6. Thiazide diuretics
    7. Birth control pills
    8. Estrogens
    9. Probenecid
    10. Reserpine
    11. Salicylates (prolonged use)
    12. Thiazide diuretics

Test value for the layman:

1. The 17-ketosteroid test is done to find any abnormality of the adrenal gland.
2. Advised if the female has hairs on the face.
   

   Normal urine picture:

   Physical features	Chemical features	Microscopic findings
   Color = Pale yellow or amber Appearance = Clear to slightly hazy pH = 4.5 to 8.0 Specific gravity = 1.015 to 1.025	Blood = Negative Glucose = Negative Ketones= Negative Protein = Negative Bilirubin = Negative Urobilinogen = Negative (±) Leucocyte esterase = Negative Nitrite for bacteria = Negative	RBCs = Rare or Negative WBC = Rare or Negative Epithelial cells = Few Cast = Negative (Occasional hyaline) Crystal = Negative (Depends upon the pH of the urine) Bacteria = Negative

    

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