The Steroid 11-Oxygenation Index; A Rapid Method for Use in the Diagnosis of Congenital Adrenal Hyperplasia

Abstract

The ratio, proposed by Hill (1960) (now called the 11-oxygenation index) of the urinary metabolites of cortisol precursors to those of cortisol, has been studied in detail. The index was determined in forty-eight adults and children without endocrine disorders. The mean was 0\m=.\32\ m=+-\0\m=.\19 (s.d.). One abnormal value (1\m=.\3) was obtained from a child found to have normal adrenals at examination post mortem.Ten patients with adrenal hyperplasia gave values of the index ranging from 1\m=.\1to 8\m=.\4.The procedure for determining the index involved borohydride reduction, periodate oxidation, formylation, paper chromatographic separation and a simplified Zimmermann reaction. Analysis of a batch of urine samples took less than 6 hr. to complete.The merits of this method and those of the other laboratory tests used in the diagnosis of adrenal hyperplasia are discussed.

Congenital Adrenal Hyperplasia and Other Conditions Associated With a Raised Urinary Steroid 11-Oxygenation Index

“…The upper limit of the normal in the investigation described here is, therefore, taken as the upper 98% confidence limit, 0-7. Although a circadian rhythm in the ll-OI was reported by Few & Collins (1969) it is not signifi¬ cant in interpreting the results reported here and by Edwards et al (1964).…”

“…It was shown previously (Edwards et al 1964) that the ll-OI value in healthy individuals was 0-32 + 0-19 (s.d.). The upper limit of the normal in the investigation described here is, therefore, taken as the upper 98% confidence limit, 0-7.…”

“…Patients who have been reported previously (Edwards et al 1964) are discussed with the present patients.…”

“…Corticotrophin (ACTH) stimulation tests were carried out as described by Clayton, Edwards & Renwick (1963). 11-01 values were determined as described by Edwards et al (1964) with two modi¬ fications. The dichloromethane extract obtained after borohydride reduction and (Smith, 1969) was replaced by 0-3 1 circular jars of 10 cm diameter (Makin, 1966).…”

A Simple Procedure for the Radioimmunoassay of 17α-Hydroxyprogesterone in Serum: Comparison with an Immunological Purification Technique

“…The measurement of serum 17-0HP concentrations as an alternative to urinary pregnanetriol excretion (Bongiovanni and Clayton, 1954;Morris, 1959) or the ll-oxygenation index (Hill, 1960;Edwards et al, 1964) has been reported for the diagnosis of patients with congenital adrenal hyperplasia due to Zl-hydroxylase deficiency (Strott et al, 1969;Pham-Huu-Trung et al, 1973), and, with some rare exceptions , pregnanetriol in urine reflects this excessive production of 17-0HP. The detection of a diminished 21-hydroxylase activity in the non-salt losing form of the disease in children and adults can be revealed by ACTH stimulation and concurrent measurement of blood levels of 17-0HP or pregnanetriol in urine Barnes and Atherden, 1972;Givens et al, 1975;Newmark et al, 1977;Parth et al, 1978).…”