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女性에서 Androgen의 分泌意義, 代謝 및 血中濃度

The Significance of Secretion, Metabolism and Plasma Concentration of Androgens in the Normal Women

대한산부인과학회지 1973년 16권 12호 p.785 ~ 797
申雄浩/Shin, W.H

Abstract


Much has been learned of the physiological properties of androgens from a wide variety of human and animal experiments. The following summary lists characteristic physiologic effects of androgens in the female: a) Genital system effects, b) Effects on sex characteristics, c) Somatic effects, d) Metabolic effects, e) Effects on behavior, etc. The biosynthetic and metabolic pathways of testosterone were dipicted diagramatically. There are three potential sources of potent androgens: not only the adrenal and the ovary, but also peripheral interconversion of mildly androgenic or even non-androgenic steroids to strongly androgenic ones. Excessive testosterone and 173-hydroxysteroids in the female are extremely virilizing, in even small amounts. The term 17 j3-hydroxysteroids refers to ether-extractable substances which displace: testosterone from. testosterone binding globulin (TBG) in the competitive protein binding assay system. Testosterone, dihydrotesterone (17(3-5a-androstan-3-one), 5a-androstenediol (androst-5-en,-3, 1713-diol) and androstanediols (5a-androstan-3s, 17(3-diol)~ appear to account for two-third of the 17A hydroxysteriods in normal women, relative more in hirsute women. Therefore, the measurement of plasma 17 j3-hydroxy steroids is predominantly a measurement of total plasma androgens. Some of these non-testosterone androgens have been shown to be elevated in hirsute women in the presence of normal testosterone levels.
Measurement of free plasma androgens would be assumed to yield more meaningful results in the assessment of androgen effect than would measurement of the total plasma androgen levels. TBG has a high affinity for androgenic 17/3-hydroxy steroids. The free plasma level of
these androgens would be expected to be dependent upon the concentration of TBG. The methods of measurement of these androgens -were described. To determine the origin of androgen overproduction in hirsute women, percutaneous adrenal and ovarian vein catheteriiation approach _ is preferable. Hvper´seeretion of the androgenic steroids may take place either in the ovary or the adrenal. Differentiation must be wherever there is virilizing state. In such individuals, by the use of metopirone and HCG stimulatory test, as well as suppression test, one can delineate the role of the adrenal gland or the ovary, in the origin of the abnormal steroidogenesis.

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