24-Hour Comprehensive Steroid Hormone Profile Interpretation

Estrogens: Estrone (E1), Estradiol (E2) and Estriol (E3)

Elevated In Women: Possible Causes

Common

• Hormone replacement therapy (oral E2 dose >0.25 mg/day)
  • * Higher transdermal doses may be used without exceeding the normal ranges
• Normal pregnancy in a pregnant woman

• Estrogen hypersecetion (high urinary concentration + low or low normal plasma concentration)
• Ovarian or adrenocortical tumors in a non-pregnant woman
• Adrenocortical hyperplasia in a non-pregnant woman
• Metabolic or hepatic disorder in a non-pregnant woman (i.e. cirrhosis)
• Treatment for infertility



• (Elevated E1 & E2 are associated with a moderate increase in breast cancer risk.)

Low In Women: Possible Causes

Common

• Menopause or peri-menopause

• Primary ovarian insufficiency, due to Stein-Leventhal syndrome
• Secondary ovarian insufficiency, due to pituitary or adrenal hypofunction
• Ovarian agenesis
• Anorexia nervosa
• Other metabolic disturbances

Elevated In Men: Possible Causes

Common

• Testosterone supplementation (>75 mg/day)

• Excessive aromatase activity (may be associated with obesity)

• DHEA supplementation
• Testicular, adrenal or hepatic tumors (may be associated with gynecomastia)
• Hepatic cirrhosis

Testosterone

Elevated In Women: Possible Causes

Common

• Testosterone supplementation

• Polycystic Ovary Syndrome (associated with hirsutism)
• Congenital adrenal hyperplasia
  • (Pregnanetriol & DHEA may also be elevated)
• Adult-onset adrenal hyperplasia
  • (Pregnanetriol & DHEA may also be elevated)
• Ovarian neoplasm
• Pregnenolone supplementation (high dose)

Elevated In Men: Possible Causes

Common

• Testosterone supplementation (>75 mg/day)

• Pregnenolone supplementation (high dose)
• XYY syndrome

Low In Men: Possible Causes

Intermediate

• Excessive aromatase activity (testosterone -> estradiol)

• Hypogonadism
• (May be associated with infertility & impotence)
• Klinefelter syndrome

Pregnanediol

Elevated In Women: Possible Causes

Common

• Progesterone supplementation
• Pregnancy

• Diffuse thecal luteinization
• Luteinized granulosa
• Theca-cell tumors
• Metastatic ovarian cancer
• High-dose pregnenolone supplementation

Low In Women: Possible Causes

Common

• Peri-menopause

• Amenorrhea
• Anovulation
• Menstrual abnormalities

Elevated In Men: Possible Causes

Uncommon

• High-dose pregnenolone supplementation
• Testicular tumors

DHEA

Elevated In Women: Possible Causes

Uncommon

• DHEA supplementation (androsterone and etiocholanolone may also increase)
• Congenital adrenal hyperplasia (pregnanetriol may also be elevated)
• Adult-onset adrenal hyperplasia (pregnanetriol may also be elevated)
  • (May present as anxiety)
• Adrenal neoplasm
• High-dose pregnenolone supplementation



• (Elevated DHEA is associated with hirsutism.)

Low In Women: Possible Causes

Common

• Age > 40 yr.

• Adrenal insufficiency
• Unipolar depression

Elevated In Men: Possible Causes

Uncommon

• DHEA supplementation (androsterone and etiocholanolone may also increase)
• Congenital adrenal hyperplasia (pregnanetriol may also be elevated)
• Adult-onset adrenal hyperplasia (pregnanetriol may also be elevated)
  • (May present as anxiety)
• Adrenal neoplasm
• High-dose pregnenolone supplementation

Low In Men: Possible Causes

Common

• Age > 40 yr.

• Adrenal insufficiency
• Unipolar depression

Etiocholanolone and Androsterone

Elevated: Possible Causes

Common

• DHEA supplementation (esp. females > 25 mg/day; males > 50 mg/day)

• Androgen producing gonadal tumors
• Congenital adrenal hyperplasia
• Adult-onset adrenal hyperplasia
• Serious illnesses (burns and others)

Low: Possible Causes

Common

• Age > 40 yr.

• Adrenal insufficiency
• Anorexia nervosa
• Panhypopituitarism
• Aging

Pregnanetriol

Elevated: Possible Causes

Uncommon

• Adrenogenital syndrome (congenital adrenal hyperplasia), which is marked by excessive adrenal androgen secretion and virilization. Women with this condition fail to develop normal secondary sex characteristics and show marked masculinization of external genitalia at birth. Men usually appear normal at birth but later develop signs of somatic and sexual precocity.



• Adult-onset adrenal hyperplasia (may present as anxiety)
  
  
• High-dose pregnenolone supplementation

Cortisol and Cortisone

Elevated: Possible Causes

Common

• Emotional or physical stress
• Intensive physical exercise

• Cortisol or cortisone administration
• Unipolar depression
• Sleep deprivation

• Cushing's syndrome (hypercortisolism)
• Cushing's disease (hypercortisolism 2° to excess ACTH production by pituitary adenoma)
• Ectopic ACTH production

Low: Possible Causes

Intermediate

• Adrenal insufficiency
  • (follow-up with ACTH challenge test or multi-point serum or saliva cortisol)
• Synthetic corticosteroid administration
• Chronic fatigue syndrome
• Fibromyalgia
• Rheumatoid arthritis

Aldosterone

Elevated: Possible Causes

Common

• Low salt diet

• Primary aldosteronism with low renin hypertension
  • (associated with polyuria and hypokalemia)
• High-dose pregnenolone supplementation
• May be elevated in patients taking spirinolactone, an aldosterone antagonist

Low: Possible Causes

Common

• High salt diet

• Adrenal insufficiency
• (In extreme cases may be associated with fatigue, hypotension, dehydration and polyuria)
• Enzyme defects in aldosterone synthesis
• Heparin administration

Tetrahydrocortisone, Tetrahydrocortisol, allo-Tetrahydrocortisol

Elevated: Possible Causes

Intermediate

• Medical or surgical stress
• ACTH, cortisone or cortisol therapy

• Cushing's Syndrome
• Hyperthyroidism
• Adrenocortical adenomas

Low: Possible Causes

Intermediate

• Synthetic corticosteroid administration
• Diabetes

• Adrenal insufficiency
• Congenital adrenal hyperplasia
• Hypothyroidism

Tetrahydrocorticosterone, allo-Tetrahydrocortisosterone

Elevated: Possible Causes

Uncommon

• 18-hydroxylase (Aldosterone synthase I) deficiency
• 18-hydroxysteroid dehydrogenase (Aldosterone synthase II) deficiency