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ANDRÉ LANTHIER, URINARY 17-KETOSTEROIDS IN THE SYNDROME OF POLYCYSTIC OVARIES AND HYPERTHECOSIS, The Journal of Clinical Endocrinology & Metabolism, Volume 20, Issue 12, 1 December 1960, Pages 1587–1600, https://doi.org/10.1210/jcem-20-12-1587
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The urinary 17-ketosteroid pattern was studied in 27 patients with polycystic ovaries and hyperthecosis (Stein-Leventhal syndrome). After dioxanc-HC1 hydrolysis of the steroids from a butanol extract of urine, the 17-ketosteroids were separated by column chromatography on silica gel, into three groups: androsterone+etiocholanolone (A+E); dehydroepiandrosterone; and the 11-oxy 17-ketosteroids. The mean value for total 17-ketosteroids was higher in the patients with the Stein-Leventhal syndrome than in normal women (P <0.01), most of the difference being due to an increase in the A+E fraction (P <0.05). A study was made of the behavior of the three urinary 17-ketosteroid fractions during stimulation with ACTH, suppression with 9αfluoroltydrocortisone, stimulation with HCG, estrogen therapy, and at intervals after bilateral wedge resection of the ovaries. The results permit no conclusions regarding adrenocortical versus ovarian origin of this increased secretion of urinary A+E precursor.
IN MOST medical text books the chapter on polycystic ovaries and hyperthecosis describes the condition under three subdivisions: a) the classic Stein-Leventhal syndrome, in which the ovaries are greatly enlarged in association with oligo-hypomenorrhea, periods of amenorrhea, infertility and hirsutism; b) a syndrome of hyperthecosis in which the ovaries are of normal size or only slightly enlarged in association with the classic clinical picture; and c) a syndrome of hyperthecosis in which the ovaries are slightly enlarged in association with meno-metrorrhagia, infertility and hirsutism. In a recent review of this subject (1) we pointed out that these three subdivisions are probably three different aspects of the same syndrome, for the following reasons: a) the salient clinical features are the same; b) the histologic pictures are almost identical; c) the mean urinary ketosteroid excretion is high; and d) all of these patients respond to bilateral ovarian wedge resection with normal menstrual periods.
