An in vitro study has been made of the
steroid metabolism in the abdominal skin in two hirsute women with
adrenogenital syndrome, and the concentrations of the various
steroids in the skin tissue have been determined. The urinary excretion of the total 17-Ks, and particularly P-triol, was pathologically high, while of the
androgens examined in the serum, primarily the levels of delta 4-dione and Test, were found to be elevated. The
21-hydroxylase deficiency meant that the plasma
ACTH level was likewise extremely high in both patients. In vitro incubation studies demonstrated that in one patient (with the higher
androgen overproduction) more Test. than normal was formed from the precursors (DHA, delta 5-diol, delta 4-dione), i.e. the biosynthetic pathway (17 beta-HSD, delta 5-3 beta-HSD) leading towards the
androgens was enhanced in the abdominal skin. In the other patient (where the
androgen production was less high as a consequence of the earlier
adrenalectomy) the metabolism in the abdominal skin was not enhanced; indeed, for many metabolites the extent of the transformation did not even attain the level for normal women. The activity of Test.
5 alpha-reductase was not increased in the skin of either patient. The results on the
steroid contents of the skin tissue revealed that numerous free
steroids (DHA, And., delta 4-dione, delta 5-diol, Test., DHT) and C19-steroid sulphates were present in higher concentrations than in the abdominal skin of healthy women. The extents of
steroid accumulation compared to the serum level in the same patient were pathologically high in the case of delta 5-diol, DHT and
DHA-S in the abdominal skin of the two hirsute women with
adrenogenital syndrome. This confirmed that a state of
hyperandrogenism does exist in the skin of these patients.