170H-progesterone rhythms in congenital adrenal hyperplasia.

Abstract

SUMMARY Serial blood spot and saliva samples were collected at home by 18 patients being treated for congenital adrenal hyperplasia to determine the circadian rhythm of 170H-progesterone as an index of therapeutic control. There was a strong correlation between the magnitude of the circadian fall and a single morning measurement of the plasma testosterone concentration taken near the time of the 170H-progesterone rhythm samples. Poor control in pubertal girls produced an exaggerated circadian fall in 170H-progesterone concentrations that were raised at all sampling times. Optimal control (plasma testosterone 1-5-2-5 nmol/l) was associated with blood spot and salivary 170H-progesterone concentrations at 0800 hours of between 30-70 nmol/l and 260-1000 pmol/l, respectively, falling thereafter to <10 nmol/l and <150 pmol/l, respectively. Similar results were obtained in prepubertal patients. Nomograms have been constructed to interpret the daily profiles of blood spot or salivary measurements of 170H-progesterone, or both. The analysis of 170H-progesterone circadian rhythms is useful in monitoring treatment in patients with congenital adrenal hyperplasia, particularly those who may be overtreated.

Monitoring of Therapy in Congenital Adrenal Hyperplasia

“…Young et al created nomograms to interpret daily profiles of salivary or blood spot 17OHP and salivary androstenedione (24,36 ). Daily profiles allow for an assessment of overall control and of medication compliance, as well as for finetuning of therapy, taking into consideration hormonal diurnal variation and response to various glucocorticoid regimens (33,37 ).…”

17OH-Progesterone Response to Acute Dexamethasone Administration in Congenital Adrenal Hyperplasia

“…Low levels of 17P were maintained for the rest of the day until a nocturnal rise, occurring in all but 1 patient. Patients with CAH, whether treated or not, typically have a noc turnal rise in 17P levels [6,7,[13][14][15][16]. The timing in this study generally occurred later than usual.…”

17-Hydroxyprogesteron im Speichel

“…Deshalb wurde von Mitte der 1970er Jahre an die Bestimmung dieses Steroids mittels Radioimmunoassay (RIA) zunächst im Serum in die Diagnostik und die Therapiekontrolle eingeführt [14,15]. Ab Ende der 1970er Jahre traten die Bestimmungen der freien, nicht proteingebundenen Fraktion des 17-OHP im Speichel mittels RIA und Enzymimmunoassay (EIA) in den Fokus des Interesses [6,13,16,17,21,22,26,27]. In der Folge wurde über Erfahrungen hiermit bei der Betreuung von Patienten mit AGS berichtet [3,7,8,9].…”

“…2). Nur in einem Fall wurde eine [3,7,16,26,27]. Nach Daten aus der Literatur scheinen auch die Bestimmungen anderer Steroide im Speichel (Testosteron, Androstendion, Progesteron) keine darüber hinaus gehenden Informationen zu liefern [15,16,21,27].…”