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What Does This Urine Test Regarding Irregular Periods Indicate?

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Posted on Tue, 15 Jul 2014
Question: Dear Doctor,

Could you please give me your take on the bellow results of a 24 hour urine collection test, in particular the androstentriol level:

Time collected 15,5h
Volume 0,583 L
U-Creatinine 18,4 nmol/L

Androgens: 27 umol/d, ref: 14-55. Mostly Etiocholanolone and Androsterone but also relatively much androstentriol (6 umol/d, ref:<3). Cortisol metabolites: 18 umol/d, ref: 12-42. Pregnanetriol: 2 umol/d, ref: <6-8.

Best regards
doctor
Answered by Dr. Binu Parameswaran Pillai (13 hours later)
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
May I ask you what was the reason for doing this test? It is important to interpret tests along with patient's clinical details. I presume that this was done as part of work for excess male hormones ? Does the patient have excess acne, hairgrowth in face/chin/chest/thighs etc? How are the periods?

The result shows normal total amount of androgens in urine. However, the androstentriol is slightly on the higher side. This is a metabolite of adrenal androgen DHEA. This probably means that there is slight increase in the DHEA production in adrenal gland which happen in variety of conditions including PCOD, CAH ( congenitral adrenal Hyperplasia) etc. However, the given urine levels are not really high

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (14 hours later)
Dear Doctor,

Thank you for your response.

The main reason for the test was excess hair growth and irregular periods.

If there is a problem with the adrenal gland, how could it be treated, and would treatment help to balance hormones so that the excess hair growth and irregular periods get better?

Regards
doctor
Answered by Dr. Binu Parameswaran Pillai (7 hours later)
Brief Answer:
Hello

Detailed Answer:
Hello ,
Good day.
DHEA is a hormone which is produced in ovaries as well as adrenals. So the source of it could be both. In PCOS, most people have excess androgen secretion from ovares. However some people may have androgen production from adrenal as well ( functional adrenal hyperndrogenism). I hope you have seen an endocrinologist and other causes of excess hair growth have been ruled out.

In PCOS, the effective way to reduce hairgrowth and regularise period is to lose weight and exercise. These two surely helps to reduce androgen levels ( by reducing the insulin levels in body. Excess insulin directly influence ovaries to produce excess androgens). Hoever, your levels are not high though.

Next step to control excess hair growth and regularise periods is by using a low dose combined hormone pill. However, it might take up to 6 months for hair growth to reduce ( hair growth cycle is 6-9 months) whilst on hormone pills. In the interim, you may use cosmetic procedures like Laser treatment to get rid of unwanted hairs.

There are some antiandrogens available which may be of use as well. However, an endocrinologist need to examine you and rule out other conditions which can mimic PCOS before starting on these tretment.

I hope your Prolactin test was normal. I have a blog on excess hairgrowth and PCOS in women. Yet to complete it. please visit www.ovarypolycystic.blogspot.in

Kind regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (40 hours later)
Dear Doctor,

Thank you for the response.

One doctor has suggested (based on the results above) that there might be a mild 3-beta-hydroxysteroid dehydrogenase deficiency. What is your take on this?

Same Doctor also communicated that a raise in androstentriol is sometimes seen in adrenal cortex cancer. Is there any reason to worry here?

Regards
doctor
Answered by Dr. Binu Parameswaran Pillai (18 minutes later)
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
As i mentioned earlier 3 beta hydroxysteroid dehydroogenase (3beta HSD) deficiency is a type of CAH ( congenital adrenal hyperplasia). In the severe form, blood pressure will be low and there is threat to life as no cortisol is formed. These patients need treatment with hydrocortisone and fludrocortisone life long. Breast size will be small as well. However, a partial ( mild) form of 3beta HSD is a possibility eventhough rare.

I would feel that a partial 21 hydroxylase deficiency type CAH is more common.If you check your blood 17 hydroxy progesterone on 3rd day of periods ( on empty stomach in the morning), that would give an idea.

I do see many of young girls with this form of CAH with severe hair growth, irregular periods etc. SOme women will have clitoris enlargement and excess libido due to excessive male hormone production.

Treatment is a combination of weight loss, exercise, and drugs like combned hormonal pills and certain steroids.

Adrenal cancer will cause production of excess hormones and the urine metabolite levels wil be much higher than your level. Hence that is extremely unlikely. Anyway, please get a scan done to clear your doubt.

I hope i answered your question. You are welcome to ask more questions. If you feel there is nothing more to ask, you may please close the query.

Wish you good health

Knd Regards
Binu
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1438 Questions

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What Does This Urine Test Regarding Irregular Periods Indicate?

Brief Answer: Hello Detailed Answer: Hello, Good day. May I ask you what was the reason for doing this test? It is important to interpret tests along with patient's clinical details. I presume that this was done as part of work for excess male hormones ? Does the patient have excess acne, hairgrowth in face/chin/chest/thighs etc? How are the periods? The result shows normal total amount of androgens in urine. However, the androstentriol is slightly on the higher side. This is a metabolite of adrenal androgen DHEA. This probably means that there is slight increase in the DHEA production in adrenal gland which happen in variety of conditions including PCOD, CAH ( congenitral adrenal Hyperplasia) etc. However, the given urine levels are not really high Regards Binu