Department of Gynaecology Hospital of the University of B-9000 Ghent, Belgium

Academic

Ghent

STEROID EXCRETION IN ANOREXIA NERVOSA PATIENTS

By E. Vanluchene, W. Aertsens and D. Vandekerckhove

ABSTRACT Seven anorexia nervosa (A. N.) patients had reduced urinary excretion values of tetrahydrocortisone (THE), androsterone (A) and 5\g=a\-tetrahydrocortisol (5\g=a\-THF). THE to tetrahydrocortisol (THF), A to aetiocholanolone (Ae) and 5\g=a\-THF to THF ratios were all significantly reduced. Six A. N. patients had oral metyrapone tests with quantitatively normal but delayed urinary 3\g=a,17\g=a,21-trihydox-5\g=bpregna-20one (THS) response.

The steroid determinations were done by capillary gaschromatography, which proves to be of value in the study of the above mentioned metabolic abnormalities.

Bradlow

al.

and Boyar et al. (1977) have pointed out the change in metabolism for A. N. patients. Using mainly infusion tests they found a "hypothyroid-like state" where 5a-reduction and 11-hydroxysteroid dehydrogenation are decreased. The routine determination of total urinary steroid profiles by means of capillary gaschromatography (Vanluchene 8c Sandra, to be published) allows of a rapid and simultaneous determination of androsterone (A), aetiocholanolone (Ae) and THS as well as of tetrahydrocortisone (THE), tetrahydrocortisol (THF) and 5a-tetrahydrocortisol (5«-THF). The present study is dealing with results in a group of A. N. patients. et

(1976)

testosterone and cortisol

MATERIALS AND METHODS From From

A. N. patients, 24 h basal urine collections were obtained at admission. patient (G. A.) another two collections were analysed during the period of weight gain. Together with clinical data, the results are summarized in Table 1. Six A. N. patients were given metyrapone in a dosage of 750 mg every 4 h during seven

one

one day. Urine was collected on the day before, during and after medication. The diagnosis of A. N. was made on the basis of characteristic history, psychiatric evalu¬ ation and the typical response to LRF stimulation (Ditoni 1975). Urine processing: one ml urine is hydrolysed enzymatically with 125 «1 Helix pomatia juice ( Industrie Biologique Française). After the addition of 5 ug 5«-cholestan3ß-ol as internal standard, an ethyl acetate extract was made and washed with 8 °/o sodium hydrogen carbonate. Reaction with O-methylhydroxylamine hydrochloride and trimethylsilylimidazole assures a complete derivatisation. Reagents are removed by ad¬ sorption on Lipidex (Packard Instr. Co.). Gaschromatography is done with 50 m OV 1 columns (inner diameter 0.05 cm), a falling needle injection system and flame ionisation detection. Mean body weight is derived from tables (Society of Actuaries 1959).

Table 1. Basal excretion values and ratios for A. N. patients and for °/o below

Patient

mean

A

THE

THF

5 -

TIIF

a

control group.

A/Ae

weight G. A.

oz

is

40

T. W.

30 22

V.M. V C. W. R. D. P.

II

19

R. N.

32

A. N.

mean -

SD

.40 1.20 2.06

1.35 3.44 3.55

1.25 3.84 4.77

1.70 2.3 3.29

.96 1.45 .40 .60 .95

2.72 4.42

2.12 2.9 .22 1.50 1.71 3.30

1.42 1.8 .21

.40

.85

2.3 2.13 4.7

.24 .51

5ct-THF

THE

THF

THF

.14

1.14

.30 .35 .58 .35 .33 .47 .26 .45 .09

.32 .30

1.63 2.31

.46 .54 .03 .30 .33 .30

.20 .13

1.49 1.61 1.05 1.50 1.05 1.43

1.0

.22 .35

.14

.30

.74 1.67 1.45

.74 .411

2.64 1.45

1.86 1.04

1.44 .67

.31 .16

.32 .13

.22 .09

1.27 .32

2.25

2.37 .71

3.24 .98

1.31 .33

.97 .38

.95 .33

.74 .24

2.50 .63