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A 22-year-old patient is described with congenital adrenal hyperplasia and spontaneous menstrual cycles who became pregnant prior to the institution of steroid therapy. During the latter part of gestation there was a progressive decrease in the daily urinary excretion of neutral 17-ketosteroids, pregnanediol and pregnanetriol. Excretion of the latter two compounds remained low until the sixteenth week, when spontaneous abortion occurred. Chromatographic separation of the urinary neutral 17-ketosteroids revealed a predominance of androsterone. Following the administration of corticotropin during pregnancy there was a pronounced increase in the urinary output of androsterone, a decrease in the output of etioeholanolone. and a rise in the ratio of androsterone to ctiocholanolone from 1.3 to 5.8. These changes took place at a time when there was no significant urinary excretion of pregnanediol and pregnanetriol. The data indicate an alteration in either the production or metabolism of progesterone and 17a-hydroxyprogesterone, and suggest that the major source of the increased androsterone was an excess adrenal production of Ci 9 steroids relative to C21 compounds. The presence of ovulatory menses in this patient demonstrates that the increased circulating androgens could not disrupt the normal pituitary-ovarian relationship despite their virilizing capabilities.

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