SYNOPSIS The use of a routine assay for urinary steroids is described that is thought to satisfy the following needs: the measurement of low levels of 17-hydroxycorticosteroid excretion; the assessment of adrenocortical activity during prednisolone therapy; the diagnosis of the adrenogenital syndrome and the monitoring of its treatment using any available urine specimen; the very early diagnosis of pregnancy using any available urine specimen. It may also prove of value in the assessment of progesterone secretion and metabolism during pregnancy.Corticosteroid assays are used for the measurement of hypo-and hyperfunction of the adrenal cortex; the assessment of iatrogenic adrenal suppression; the measurement of the degree of adrenal stimulation induced with ACTH; the diagnosis of the adrenogenital syndrome and the assessment of its treatment. If a single quick routine assay could provide unequivocal information for each of these needs and could provide, in addition, an early dignosis of pregnancy and an assessment of the excretion of a number of pregnancy steroids it would be of considerable use. This paper describes the clinical use of an assay that appears to provide such information.
METHODSDetails of the routine assay procedure for urinary 17-hydroxycorticosteroids (17-OHCS) have been published (Murphy and West, 1966). In brief, 10 ml of urine (or much less, in special circumstances, made up to 10 ml with distilled water) is adjusted to pH 7 and 1 ml of potassium borohydride solution (15% in 0-1 N NaOH) added. After heating at 60°C for 50 min 1 ml of 25% acetic acid is added followed, in 2 min, by 4 ml of sodium metaperiodate solution (10% aqueous) and the heating continued for a further 10 minutes. One ml of 5 N NaOH is then added and the products extracted with 20 ml of ethylene dichloride. The extract is filtered through sodium sulphate and evaporated to dryness before acetylation at 60°C for 30 min with 0-2 ml of pyridine and 0-1 ml of acetic anhydride. The reagents are then evaporated under nitrogen and the residue dissolved in 0-4 ml ethanol for gas chromatography. When it has been necessary to obtain more information by forming trimethylsilyl ether (TMSi) derivatives, of the C,3 and C,17 hydroxyl functions, this was effected as follows. The dry unacetylated Received for publication 25 October 1967. extracts were reacted with 0-2 ml of purified pyridine and 0-1 ml of hexamethyldisilazane overnight at room temperature. The reagents were then evaporated under nitrogen and the residue was dissolved in 04 ml of ethylene dichloride ready for gas chromatography. The acetates were gas chromatographed at 235°C and the TSMi ether derivatives at 210°C. In the routine 17-OHCS assay the major C,21 metabolites of cortisol, ie, the glucosiduronates of tetrahydrocortisol, tetrahydrocortisone, the cortols, the cortolones and their 5a isomers are converted to 11 ,-hydroxyactiocholanolone and lI1p-hydroxyandrosterone and these are measured together in a single gas chromatograph peak. Pregnanetriol is converted to aeti...